Biopsy pathology in uveitis

Abstract

Uveitis is fraught with speculations and suppositions with regard to its etiology, progress and prognosis. In several clinical scenarios what may be perceived as due to a systemic infection may actually not be so and the underlying etiology may be an autoimmune process. Investigations in uveitis are sometimes the key in identification and management. Invasive techniques could be of immense value in narrowing down the etiology and help in identifying the cause. This article updates one on the invasive techniques used in biopsy such as anterior chamber paracentesis, vitreous tap and diagnostic vitrectomy, iris and ciliary body biopsy, choroidal and retinochoroidal biopsy and fine needle aspiration biopsy (FNAB). In populations where certain infections are endemic, the clinical scenario does not always respect a known presentation and the use of biopsy is resorted to as a sure way of confirming the etiology. Biopsies have a role in diagnosis of several inflammatory and infectious conditions in the eye and are pivotal in diagnosis in several dilemmas such as intraocular tumors and in inflammations. Appropriate and timely use of biopsy in uveitis could enhance the diagnosis and provide insight into the etiology, thus enabling precise management.

Keywords: Anterior Chamber Paracentesis; Choroidal and Retinochoroidal Biopsy and Fine Needle Aspiration Biopsy; Iris and Ciliary Body Biopsy; Vitreous Tap and Diagnostic Vitrectomy.

Figure 1

Hypopyon in an eight year old girl

Figure 2

Anterior chamber aspirate showing multiple basophilic cells with pleomorphic nuclei suggestive of retinoblastoma (H and E, ×400)

Figure 3

Granulomatous uveitis with mutton fat keratic precipitates, posterior synechiae, traumatic cataract and ruptured anterior capsule of the lens

Figure 4

Anterior chamber aspirate of the same patient showing macrophages with engulfed matter (H and E, ×400)

Figure 5

Color fundus montage photograph showing subretinal mass

Figure 6

Fine needle aspiration biopsy showing pleomorphic malignant cells in necrotic background (H and E, ×100)