title: 25-Gauge transconjunctival sutureless vitrectomy for the diagnosis of intraocular lymphoma.
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.
authors.affiliation: Laboratory of Immunology, National Eye Institute, National Institutes of Health, Building 10, 10N-112, 10 Center Drive, Bethesda, MD 20892, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Yeh
authors.forename: Eric D
authors.initials: ED
authors.lastname: Weichel
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Faia
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Albini
authors.forename: Keith K
authors.initials: KK
authors.lastname: Wroblewski
authors.forename: Maryalice
authors.initials: M
authors.lastname: Stetler-Stevenson
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: H Nida
authors.initials: HN
authors.lastname: Sen
authors.forename: Chi Chao
authors.initials: CC
authors.lastname: Chan
authors.forename: Robert B
authors.initials: RB
authors.lastname: Nussenblatt
mesh_terms: D000328:Adult; D000368:Aged; D005134:Eye Neoplasms / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods; D013537:Sutures; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
references.citation: Ophthalmology. 2003 Aug;110(8):1671-2
references.pmid: 12917196
references.citation: Semin Hematol. 2001 Apr;38(2):111-23
references.pmid: 11309693
references.citation: Am J Clin Pathol. 2004 Apr;121(4):464-72
references.pmid: 15080297
references.citation: Am J Ophthalmol. 2005 Nov;140(5):822-829
references.pmid: 16310459
references.citation: Retina. 2008 Jul-Aug;28(7):941-6
references.pmid: 18698295
references.citation: Retina. 2008 Feb;28(2):249-57
references.pmid: 18301030
references.citation: Arch Ophthalmol. 1999 Sep;117(9):1239-42
references.pmid: 10496399
references.citation: Am J Ophthalmol. 1991 Oct 15;112(4):472-4
references.pmid: 1928262
references.citation: Ophthalmology. 2007 Oct;114(10):1893-7
references.pmid: 17509687
references.citation: Trans Am Ophthalmol Soc. 2003;101:275-92
references.pmid: 14971583
references.citation: Can J Ophthalmol. 1992 Jun;27(4):168-71
references.pmid: 1633587
references.citation: Diagn Mol Pathol. 1992 Sep;1(3):173-9
references.pmid: 1342963
references.citation: Invest Ophthalmol Vis Sci. 1999 Sep;40(10):2462-3
references.pmid: 10476821
references.citation: Ophthalmology. 1998 Sep;105(9):1664-9
references.pmid: 9754175
references.citation: Ophthalmology. 1992 Feb;99(2):250-6
references.pmid: 1553217
references.citation: Br J Ophthalmol. 2007 Jul;91(7):945-8
references.pmid: 17202200
references.citation: Ophthalmology. 1993 May;100(5):705-14
references.pmid: 8493014
references.citation: Ophthalmology. 1993 Nov;100(11):1677-84
references.pmid: 8233394
references.citation: Ophthalmology. 2005 May;112(5):817-24
references.pmid: 15878061
references.citation: Am J Ophthalmol. 1995 Nov;120(5):671-3
references.pmid: 7485372
references.citation: Am J Ophthalmol. 1997 Sep;124(3):362-72
references.pmid: 9439362
references.citation: Ophthalmology. 1993 Sep;100(9):1399-406
references.pmid: 8371930
references.citation: Curr Opin Ophthalmol. 2007 May;18(3):188-93
references.pmid: 17435424