Primary Vitreoretinal Lymphoma Presenting Solely With Asymptomatic Peripheral Drusenoid Lesions

This case report describes the first known instance of primary vitreoretinal lymphoma (PVRL) presenting solely with asymptomatic peripheral drusenoid lesions in a woman in her 70s. Initially mistaken for benign age-related changes, the lesions were later identified as B-cell lymphoma after a diagnostic vitrectomy. Despite initial treatment with radiation therapy to both orbits, the disease progressed, requiring systemic chemotherapy with methotrexate. The case highlights the need for high clinical suspicion for malignancy in older patients with new retinal lesions, as PVRL can present with non-specific symptoms and is often misdiagnosed. It emphasizes the challenges in managing PVRL, noting that local radiation alone may not prevent progression to central nervous system involvement, and systemic chemotherapy is often necessary.