25-Gauge transconjunctival sutureless vitrectomy for the diagnosis of intraocular lymphoma

Abstract

BACKGROUND/AIMS Diagnostic pars plana vitrectomy is a useful technique in the diagnosis of intraocular lymphoma (IOL); however, the role of transconjunctival sutureless vitrectomy (TSV) has not been fully explored for this indication. The purpose of this study was to review our experience with 25-gauge TSV for the diagnosis of IOL. METHODS Patients who underwent 25-gauge TSV for the diagnosis of IOL (primary, secondary or recurrent) from two tertiary referral centres were reviewed. Demographic data and underlying medical conditions were reviewed. Preoperative and postoperative visual acuities (VA) and ophthalmic examination data were assessed. Cytopathology, flow cytometry, cytokine and gene rearrangement studies were assessed. RESULTS Twelve patients underwent 25-gauge diagnostic TSV with a median follow-up time of 37 weeks. B-cell or T-cell IOL was diagnosed based on cytology in 3/12 patients (25%, 95% CI 8.9 to 53.2%) and in eight patients (67%, 95% CI 39.1 to 86.1%) using adjunctive diagnostic testing. VA stabilised or improved in 11 eyes (92%). Mean VA improved from 20/95 to 20/66 (p=0.055, paired t test). CONCLUSIONS 25-Gauge TSV is safe and effective for obtaining vitreous specimens for the evaluation of IOL. The availability of expert ophthalmic pathological consultation, flow cytometry, cytokine evaluation and gene rearrangement studies were essential to the diagnosis.

Figure 1

Patient 9 was a 52-year-old male patient who had a history of an intra-abdominal mass impinging on the right renal pelvis. Ophthalmic examination showed 1–2+ vitreous cell, trace vitreous haze and retinal pigment epithelium (RPE) mottling with a ‘leopard-skin’ pattern (A). Diagnostic vitrectomy revealed large atypical lymphocytes consistent with intraocular lymphoma (B). Fluorescein angiography showed mottled hyperfluorescence (C) and an area of late leakage with a serous detachment temporal to the fovea (D).

Figure 2

Patient 3 was a 54-year-old Caribbean woman with a history of systemic HTLV-1-associated T-cell lymphoma who presented with bilateral vitritis and retinal vasculitis (A, B). Fundus photograph of posterior pole revealed 1–2+ vitreous haze with 2+ vitreous cells (C) and prominent peripheral retinal vascular sheathing (D). Vitreous cytology, flow cytometry and T-cell receptor gene rearrangement studies from a diagnostic transconjunctival sutureless vitrectomy (TSV) specimen were consistent with intraocular T-cell lymphoma.