Purpose To evaluate fundus autofluorescence (FAF) patterns in patients with primary intraocular (vitreoretinal) lymphoma (PIOL/PVRL). Methods Records of all PIOL patients who underwent FAF imaging at the National Eye Institute (NEI) were reviewed. FAF patterns were evaluated with respect to clinical disease status and the findings on fluorescein angiography (FA) and spectral-domain optical coherence tomography (SD-OCT) images. Results There were 18 eyes (10 patients) with PIOL who underwent FAF imaging. Abnormal autofluorescence in the form of granular hyper- and hypoautofluorescence was seen in 11 eyes (61%) and blockage by mass lesion was seen in 2 eyes (11%). All eyes with granular pattern on FAF had active PIOL at the time of imaging, but there were 5 eyes with unremarkable FAF which were found to have active lymphoma. The most common pattern on FA was hypofluorescent round spots with a “leopard-spot” appearance (43%). These hypofluorescent spots on FA correlated to hyperautofluorescent spots on FAF in 5 (36%) eyes (inversion of FAF). Nodular hyperreflective spots at the level of RPE on OCT were noted in 43% of eyes. The hyperautofluorescent spots on FAF correlated with nodular hyperreflective spots on OCT in 6 eyes (43%). Conclusion Granularity on fundus autofluorescence was associated with active lymphoma in majority of cases. An inversion of FAF (hyperautofluorescent spots on FAF corresponding to hypofluorescent spots on FA) was observed in less than half of the eyes.

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