Vitreous diagnosis in neoplastic diseases

Abstract

Vitreous body is an intraocular structure, origin of diverse pathologies, but is also the place where cells and inflammatory mediators are released coming from several pathologic processes. These inflammatory reactions can happen in any other ocular location like choroid, retina, optic nerve, or ciliary body and vitreous humor constitutes a stagnant reservoir for these resulting substances and debris. Through the recent techniques of vitreous collecting, handling, and analysis, increasingly more sophisticated and with fewer complications, cellularity and molecules in the vitreous of challenging pathologies for the ophthalmologist can now be studied. The most usefulness for vitreous diagnosis would be the masquerade syndromes, and the best exponent in this group is the primary vitreoretinal lymphoma (PVRL), in which cytology and an IL-10/IL-6 ratio more than 1 is fundamental for the diagnosis.

Figure 1

Set for manual Fine-needle aspiration biopsy/cytology, composed of 10 mL syringe, extension tube with a three-way stopcock, and long 27-gauge needle.

Figure 2

Case 1: (a) healthy right eye of the same patient, (b) left eye vitreitis in a healthy patient that was finally diagnosed of primary vitreoretinal lymphoma by vitrectomy. Case 2: (a) hemorrhagic hypopion in a patient with primary thoracic B-cell Hodgkin's lymphoma in clinical remission. After unsuccessful anti-inflammatory and antibiotic treatment an anterior chamber paracentesis was performed confirming the diagnosis of metastatic lymphoma, (b) external aspect of the eye after treatment with intravitreal methotrexate.