Diagnostic cellular yield is superior with full pars plana vitrectomy compared with core vitreous biopsy

Abstract

Purpose Vitreous biopsy for the cytological assessment of suspected intraocular lymphoma and vitritis of uncertain aetiology is a standard investigation. The types of specimens generated and the diagnostic rate are variable within and between centres. There are many reasons for this but one observation that has not been considered previously is the differential distribution of cells in the vitreous gel. To test this possibility, five consecutive patients with suspected vitreous involvement by lymphoma or vitritis of uncertain aetiology underwent a core vitreous biopsy immediately before a planned full pars plana vitrectomy (PPV) and the cellularity of the two sampling techniques compared. Methods A prospective study of five consecutive patients requiring vitreous sampling to secure a firm diagnosis. For each of five patients, the core vitreous biopsy specimen was received in a universal tube and the PPV specimen was received in a vitreous cassette. Fluid (0.25 ml) was removed from both specimens, centrifuged and haematoxylin and eosin (H&E) stained slides prepared per sampling method. The slides were examined with a light microscope, the most cellular field selected and the number of cells per mm 2 counted and compared between sampling techniques. Results PPV specimen's, revealed a cellularity range that was 7.4 to 78 Â (average 31 Â ) greater than a core vitreous biopsy. In the two cases of a final diagnosis of intraocular lymphoma, the vitreous core biopsy was non-diagnostic. Furthermore, the PPV specimen generated additional cellular material for numerous ancillary investigations to permit a secure diagnosis. Conclusions The results of this differential vitreous sampling study has strengthened our anecdotal slit lamp clinical observations that inflammatory cells and lymphoma cells are concentrated more in the cortical vitreous. Therefore, vitreous cells have less chance to be sampled if a single core vitreous biopsy is performed. Indeed, the two cases of confirmed lymphoma generated a non-diagnostic core vitreous biopsy. In our centre, this study has lead to PPV being performed as a gold standard on all patients with suspected intraocular lymphoma or vitritis of uncertain aetiology.

Two cases of intraocular lymphoma diagnosed by analyses of vitreous and infusion fluid

“…First, a larger number of cells can be collected. Mudhar et al reported that the lymphoma cells were concentrated more in the cortical vitreous than core vitreous 10. Additionally, Conlon et al reported that vitrectomy did not cause any more cellular degradation than simple aspiration 11.…”

Vitrectomy for Complicated Posterior Uveitis

“…It is also helpful for obtaining the GoldmannWitmer quotient. Cytology and fl ow cytometry, even with such small samples, can be helpful for diagnosis [ 24 ]. Case series of diagnostic vitrectomies reported yields from 30 to 81.6 % [ 25 ].…”

“…Apart from allowing the visualization of the fundus and allowing better diffusion of intraocular medications, the vitrectomy also has the advantage of yielding more samples with enough material available for multiple tests. Studies have also shown a better yield from samples which have been obtained closer to the retina, theorizing that these cells may be more viable compared to the more distal cells [ 24 ].…”

Intraocular T-cell Lymphoma: Clinical Presentation, Diagnosis, Treatment, and Outcome

“…5,11,44 Diagnostic cellular yield is superior with full pars plana vitrectomy compared with core vitreous biopsy. 56 The gold standard remains the cytopathologic examination. However, immunophenotyping, flow cytometry, and molecular analysis are helpful to improve the diagnostic accuracy.…”