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Clinical science
25-Gauge transconjunctival sutureless vitrectomy for the diagnosis of intraocular lymphoma
  1. Steven Yeh1,
  2. Eric D Weichel1,2,
  3. Lisa J Faia1,
  4. Thomas A Albini3,
  5. Keith K Wroblewski1,2,
  6. Maryalice Stetler-Stevenson4,
  7. Phillip Ruiz5,
  8. H Nida Sen1,
  9. Chi Chao Chan1,
  10. Robert B Nussenblatt1
  1. 1National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
  2. 2Department of Ophthalmology, Walter Reed Army Medical Center, Washington, USA
  3. 3Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
  4. 4Flow Cytometry Unit, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  5. 5Departments of Surgery and Pathology, University of Miami Miller School of Medicine, Miami, Florida, USA
  1. Correspondence to Dr Robert B Nussenblatt, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Building 10, 10N-112, 10 Center Drive, Bethesda, MD 20892, USA; DrBob{at}nei.nih.gov

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.

  • Diagnostic tests/investigation, neoplasia
  • retina
  • pathology
  • vitreous

https://doi.org/10.1136/bjo.2009.167940

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    Footnotes

    • This research was presented in part at the American Society of Retinal Specialists annual meeting in Maui, Hawaii, USA, in October 2008.

    • Funding This research is supported by Intramural Research Program of the National Eye Institute, National Institutes of Health. SY has received support from the Heed Ophthalmic Foundation and the Ronald G. Michels Foundation.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval This study was conducted with the approval of the National Eye Institute, National Institutes of Health; Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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