Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation

ABSTRACT.Purpose: In this prospective study, a universal protocol for sampling and analysing vitreous material was investigated. Vitreous biopsies are difficult to handle because of the paucity of cells and the gelatinous structure of the vitreous. Histopathological analysis of the vitreous is useful in difficult uveitis cases to differentiate uveitis from lymphoma or infection and to define the type of cellular reaction. Methods: Hundred consecutive vitreous samples were analysed with the Cellient â tissue processor (Hologic). This machine is a fully automated processor starting from a specified container with PreservCyt â (fixative fluid) with cells to paraffin. Cytology was compared with fixatives Cytolyt â (contains a mucolyticum) and PreservCyt â . Routine histochemical and immunostainings were evaluated. Results: In 92% of the cases, sufficient material was found for diagnosis. In 14%, a Cytolyt â wash was necessary to prevent clotting of the tubes in the Cellient â due to the viscosity of the sample. In 23%, the diagnosis was an acute inflammation (presence of granulocytes); in 33%, chronic active inflammation (presence of T lymphocytes); in 33%, low-grade inflammation (presence of CD68 cells, without T lymphocytes); and in 3%, a malignant process. Conclusion: A standardized protocol for sampling and handling vitreous biopsies, fixing in PreservCyt â and processing by the Cellient â gives a satisfactory result in morphology, number of cells and possibility of immuno-histochemical stainings. The diagnosis can be established or confirmed in more than 90% of cases.

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“…; Matsuo & Ichimura ; Scott et al. ). All publications focus on the difficulties for handling the specimens (Mruthyunjaya et al.…”

Section: Discussionmentioning

confidence: 99%

A new and standardized method to sample and analyse vitreous samples by the Cellient^® automated cell block system

Ginderdeuren

Calster

Stalmans

et al. 2014

Acta Ophthalmologica

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“…Cytological analysis using vitreous specimen may also contribute to the diagnosis of sarcoidosis in selected cases,14 especially when laboratory data and ancillary test are not consistent with a diagnosis of sarcoidosis. In some cases, vitrectomy is expected to improve visual acuity and to stabilise vitreous inflammation 15.…”

Section: Discussionmentioning

confidence: 99%

Propionibacterium acnesas a possible pathogen of granuloma in patients with ocular sarcoidosis

et al. 2017

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“…Scott et al reported eight vitreous specimens among 150 consecutive eyes that underwent diagnostic vitrectomy in a single institution that were consistent with sarcoidosis. 100 Only one of these patients with a normal chest X-ray had a chest CT. Two studies reported that CD4 þ/CD8þ ratios of vitreous lymphocytes were significantly higher in sarcoid uveitis versus other forms of uveitis. 101,102 The sensitivity and specificity of the vitreous CD4 þ/CD8þ ratio were 100 and 96.3%, respectively, for the diagnosis of intraocular sarcoidosis, suggesting a diagnostic value comparable to that of the CD4 þ/CD8þ ratio in BAL fluid for pulmonary sarcoidosis.…”

Section: New Diagnostic Toolsmentioning

confidence: 99%

Ocular Sarcoidosis

Sève

Jamilloux

Tilikete

et al. 2020

Semin Respir Crit Care Med

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Sarcoidosis is one of the leading causes of inflammatory eye disease. Any part of the eye and its adnexal tissues can be involved. Uveitis and optic neuropathy are the main manifestations, which may require systemic treatment. Two groups of patients with sarcoid uveitis can be distinguished: one of either sex and any ethnicity in which ophthalmological findings are various and another group of elderly Caucasian women with mostly chronic posterior uveitis. Clinically isolated uveitis revealing sarcoidosis remains a strictly ocular condition in a large majority of cases. Although it can be a serious condition involving functional prognosis, early recognition in addition to a growing therapeutic arsenal (including intravitreal implant) has improved the visual prognosis of the disease in recent years. Systemic corticosteroids are indicated when uveitis does not respond to topical corticosteroids or when there is bilateral posterior involvement, especially macular edema. In up to 30% of the cases that require an unacceptable dosage of corticosteroids to maintain remission, additional immunosuppression is used, especially methotrexate. As with other forms of severe noninfectious uveitis, monoclonal antibodies against tumor necrosis factor-α have been used. However, only very rarely does sarcoid uveitis fail to respond to combined corticosteroids and methotrexate therapy, a situation that should suggest either poor adherence or another granulomatous disease. Optic neuropathy often affects women of African and Caribbean origins. Some authors recommend that patients should be treated with high-dose of corticosteroids and concurrent immunosuppression from the onset of this manifestation, which is associated with a poorer outcome.

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Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation

Cited by 16 publications

References 33 publications

A new and standardized method to sample and analyse vitreous samples by the Cellient^® automated cell block system

A new and standardized method to sample and analyse vitreous samples by the Cellient^® automated cell block system

Propionibacterium acnesas a possible pathogen of granuloma in patients with ocular sarcoidosis

Ocular Sarcoidosis

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Diagnostic yield of vitreous biopsy in presumed sarcoidosis-related posterior segment inflammation

Cited by 16 publications

References 33 publications

A new and standardized method to sample and analyse vitreous samples by the Cellient® automated cell block system

A new and standardized method to sample and analyse vitreous samples by the Cellient® automated cell block system

Propionibacterium acnesas a possible pathogen of granuloma in patients with ocular sarcoidosis

Ocular Sarcoidosis

Contact Info

Product

Resources

About

A new and standardized method to sample and analyse vitreous samples by the Cellient^® automated cell block system

A new and standardized method to sample and analyse vitreous samples by the Cellient^® automated cell block system