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Maggio E, Bauci F, Polito A, Arena F, Pertile G. Swept-source optical coherence tomography angiography findings in a case of primary vitreoretinal lymphoma over a three-year follow-up. BMC Ophthalmol 2024; 24:194. [PMID: 38664667 PMCID: PMC11044339 DOI: 10.1186/s12886-024-03438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Vitreoretinal lymphoma (VRL) still represents a diagnostic challenge for retinal specialists. Early diagnosis and treatment are critical for a better prognosis. Several diagnostic tools have proven helpful in the identification of VRL abnormalities. However, swept-source OCT angiography (SS-OCT-A) findings and their long-term follow-up are yet to be explored. CASE PRESENTATION a 42-year-old man presented with blurred vision in his left eye for 2 weeks. He denied any systemic symptoms. A multimodal imaging examination was performed, raising the clinical suspicion of VRL and guiding the ensuing diagnostic procedures. The patient underwent treatment and at the last FU visit three years later, no disease signs were present on fundus examination, nor on oncologic evaluation. Some novel SS-OCT-A features were identified, and uncommonly reported findings were examined over a long-term follow-up. At baseline multiple hyperreflective alterations were detected on the enface outer retina slabs and choriocapillary analysis revealed low reflectance areas in the foveal and parafoveal areas. One month after the first presentation, multiple hyperreflective retinal lesions in a vertical shape were detected on OCT which appeared on midretinal slabs of enface SS-OCT-A as hyperreflective spots mainly located near second-order retinal vessels. These alterations remarkably reduced after treatment. CONCLUSION SS-OCT-A may be a useful imaging technique in the detection of VRL, providing ophthalmologists additional findings that assist the diagnosis and follow-up of this disease. This may prove useful for a more timely and precise diagnosis, prompt therapy, and treatment response monitoring. The original aspects found in this case may provide grounds for future studies, ultimately fostering a better understanding of the disease.
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Affiliation(s)
- Emilia Maggio
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, Negrar, Verona, 37024, Italy.
| | - Francesco Bauci
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, Negrar, Verona, 37024, Italy
| | - Antonio Polito
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, Negrar, Verona, 37024, Italy
| | - Fabrizio Arena
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, Negrar, Verona, 37024, Italy
| | - Grazia Pertile
- IRCCS Sacro Cuore Don Calabria Hospital, Via Don Sempreboni 5, Negrar, Verona, 37024, Italy
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Mehta N, Scholle T, Chevez-Barrios P, Schefler AC, Weng CY. PRIMARY CENTRAL NERVOUS SYSTEM AND VITREORETINAL LYMPHOMA MIMICKING VIRAL RETINITIS IN A YOUNG PATIENT. Retin Cases Brief Rep 2023; 17:567-571. [PMID: 37643044 DOI: 10.1097/icb.0000000000001255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to report a young immunocompetent patient with primary central nervous system and vitreoretinal lymphoma initially presenting with peripheral retinitis. METHODS This study is a case report. RESULTS A 31-year-old woman presented with 20/60 vision in her left eye, vitreous haze, and peripheral retinal whitening. Intravitreal and oral antivirals were initiated for presumed acute retinal necrosis. Anterior chamber paracentesis was negative for viral nucleotide. Subretinal infiltrates developed, and vitreous biopsy was performed and interpreted as "negative except for rare yeast." Antifungal therapy was initiated. She developed multiple unilateral cranial neuropathies with multifocal areas of enhancement on neuroimaging. Lumbar puncture cytology was negative for neoplastic cells. After further worsening, aforementioned specimens were sent to a specialized ophthalmic pathology laboratory and the diagnosis revised to lymphoma of the diffuse B-cell type. Initial disease regression was seen after combined systemic and intraocular chemotherapy; unfortunately, the patient suffered a central nervous system recurrence and died from systemic complications 1 year later. CONCLUSION There has been an increased incidence of primary central nervous system and vitreoretinal lymphoma in young patients. Although vitreous biopsy is the diagnostic gold standard for vitreoretinal lymphoma, a risk of false negative interpretation exists. A high index of suspicion and expert interpretation of pathology may be necessary to secure the correct diagnosis.
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Affiliation(s)
- Nitish Mehta
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
| | - Tahira Scholle
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
| | - Patricia Chevez-Barrios
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Houston, Texas; and
| | - Amy C Schefler
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Houston, Texas; and
- Retina Consultants of Texas and Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas
| | - Christina Y Weng
- Department of Ophthalmology-Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
- Department of Ophthalmology, Ben Taub General Hospital, Houston, Texas
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3
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Abou-Samra A, McTavish S, Whitehair R, Shildkrot YE. Hit and Run: Bilateral Massive Intraocular Lymphomatous Infiltration after CAR-T Therapy. Ocul Immunol Inflamm 2023:1-4. [PMID: 36952531 DOI: 10.1080/09273948.2023.2191713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
PURPOSE We report a case of bilateral intraocular infiltration of DLBCL after CAR-T therapy. METHODS Retrospective case report. RESULTS A 62-year-old Caucasian male with medical history of high-grade DLBCL presented with papillitis and vitritis upon completion of CAR-T therapy. Thorough infectious and diagnostic work-ups were performed. Diagnostic vitreous tap revealed intraocular lymphoma. The patient received external beam radiotherapy to both orbits with dramatic improvement in disc edema and vitritis. However, subsequent MRI showed development of intracranial metastatic disease, and the patient died within the same month. CONCLUSION Atypical intraocular metastasis of DLBCL may occur following CAR-T therapy and may indicate secondary changes in immunosurveillance within immune-privileged sites such as the eye.
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Affiliation(s)
- Abdullah Abou-Samra
- Department of Ophthalmology, University of Virginia, Charlottesville, Virginia, USA
| | - Sloane McTavish
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rachel Whitehair
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
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4
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Gozzi F, Aldigeri R, Mastrofilippo V, De Simone L, Bolletta E, Marzano J, Iannetta D, Coassin M, Ilariucci F, Ferrari A, Luminari S, Merli F, Croci S, Zerbini A, Farnetti E, Nicoli D, Valli R, Tamagnini I, Cavazza A, Salvarani C, Fontana L, Cimino L. Survival and Recurrence in Vitreoretinal Lymphoma Simulating Uveitis at Presentation: The Possible Role of Combined Chemotherapy. Ocul Immunol Inflamm 2022; 30:1833-1841. [PMID: 34379571 DOI: 10.1080/09273948.2021.1962916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate the role of combined systemic and local chemotherapy in improving the survival of patients with vitreoretinal lymphoma (VRL). METHODS Patients with VRL consecutively seen from 2006 to 2020 were retrospectively reviewed; data on the presence and time of central nervous system (CNS) involvement and treatment regimen (systemic, local or combined chemotherapy) were collected. Overall survival (OS) and progression-free survival (PFS) were calculated for each group. RESULTS Forty-three eyes of 22 subjects with histology-proven VRL were included. Mean time of survival was 64.8 months (SE±10.8). Twelve patients (57%) presented CNS involvement, which was significantly associated with progression (r = 0.48, P = .03) and death (r = 0.56, P = .009). The isolated primary VRL group had a 5-year OS of 80%. Combined systemic and local chemotherapy reduced the risk of death by 82% (hazard ratio 0.18[0.04- 0.85]) in the entire cohort. CONCLUSION Combined systemic and local chemotherapy significantly improved OS but not PFS of patients affected by VRL.
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Affiliation(s)
- Fabrizio Gozzi
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | | | | | - Luca De Simone
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Elena Bolletta
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Jacopo Marzano
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Marco Coassin
- Department of Ophthalmology, University Campus Bio-Medico of Rome, Rome, Italy
| | | | - Angela Ferrari
- Hematology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Stefano Luminari
- Hematology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.,Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Alessandro Zerbini
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Enrico Farnetti
- Molecular Biology Laboratory, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Davide Nicoli
- Molecular Biology Laboratory, Azienda USL-IRCCS, Reggio Emilia, Italy
| | | | | | | | - Carlo Salvarani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, with Interest in Transplants, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Rheumatology Unit, Azienda USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Fontana
- Ophthalmology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
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Chen T, Liu Y, Wang Y, Chang Q, Wu J, Wang Z, Geng D, Yu JT, Li Y, Li XQ, Chen H, Zhuang D, Li J, Wang B, Jiang T, Lyu L, Song Y, Qiu X, Li W, Lin S, Zhang X, Lu D, Lei J, Chen Y, Mao Y. Evidence-based expert consensus on the management of primary central nervous system lymphoma in China. J Hematol Oncol 2022; 15:136. [PMID: 36176002 PMCID: PMC9524012 DOI: 10.1186/s13045-022-01356-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/19/2022] [Indexed: 08/30/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a type of central nervous system restricted non-Hodgkin lymphoma, whose histopathological diagnosis is majorly large B cell lymphoma. To provide specific, evidence-based recommendations for medical professionals and to promote more standardized, effective and safe treatment for patients with PCNSL, a panel of experts from the Chinese Neurosurgical Society of the Chinese Medical Association and the Society of Hematological Malignancies of the Chinese Anti-Cancer Association jointly developed an evidence-based consensus. After comprehensively searching literature and conducting systematic reviews, two rounds of Delphi were conducted to reach consensus on the recommendations as follows: The histopathological specimens of PCNSL patients should be obtained as safely and comprehensively as possible by multimodal tomography-guided biopsy or minimally invasive surgery. Corticosteroids should be withdrawn from, or not be administered to, patients with suspected PCNSL before biopsy if the patient's status permits. MRI (enhanced and DWI) should be performed for diagnosing and evaluating PCNSL patients where whole-body PET-CT be used at necessary time points. Mini-mental status examination can be used to assess cognitive function in the clinical management. Newly diagnosed PCNSL patients should be treated with combined high-dose methotrexate-based regimen and can be treated with a rituximab-inclusive regimen at induction therapy. Autologous stem cell transplantation can be used as a consolidation therapy. Refractory or relapsed PCNSL patients can be treated with ibrutinib with or without high-dose chemotherapy as re-induction therapy. Stereotactic radiosurgery can be used for PCNSL patients with a limited recurrent lesion who were refractory to chemotherapy and have previously received whole-brain radiotherapy. Patients with suspected primary vitreoretinal lymphoma (PVRL) should be diagnosed by vitreous biopsy. PVRL or PCNSL patients with concurrent VRL can be treated with combined systemic and local therapy.
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Affiliation(s)
- Tong Chen
- Department of Hematology, Institute of Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
| | - Yuanbo Liu
- Department of Hematology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yang Wang
- Department of Radiation Oncology, Huashan Hospital, Fudan University, Shanghai, 201107, China.,National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Qing Chang
- Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China
| | - Jinsong Wu
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China.,Institute of Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Zhiliang Wang
- Department of Ophthalmology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jin-Tai Yu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yuan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Xiao-Qiu Li
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Hong Chen
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Dongxiao Zhuang
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Jianyong Li
- Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Bin Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Lanting Lyu
- School of Public Administration and Policy, Health Technology Assessment and Policy Evaluation Group, Renmin University of China, Beijing, 100872, China
| | - Yuqin Song
- Department of Lymphoma, Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Xiaoguang Qiu
- Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Wenbin Li
- Department of Neuro-Oncolgoy, Cancer Center, National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Song Lin
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xinghu Zhang
- Department of Neurology, Neuroimmunology and Neuroinfection Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Dehong Lu
- Department of Pathology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Junqiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, 730000, China
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China. .,WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou University, Lanzhou, 730000, China. .,Lanzhou University GRADE Center, Lanzhou, 730000, China.
| | - Ying Mao
- Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China. .,Institute of Medicine, Huashan Hospital, Fudan University, Shanghai, 200040, China.
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Smith JR, Farrall AL, Davis JL, de Boer JH, Hall AJ, Mochizuki M, Sen HN, Takase H, Ten Dam-van Loon NH, Touitou V, Vasconcelos-Santos DV, Wilson DJ, Yeh S, Radford MHB. The International Vitreoretinal B-Cell Lymphoma Registry: a protocol paper. BMJ Open 2022; 12:e060701. [PMID: 35902200 PMCID: PMC9341180 DOI: 10.1136/bmjopen-2021-060701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Vitreoretinal lymphoma is a rare ocular cancer with high morbidity and mortality despite treatment. Diagnosis by cytopathology is often delayed, and various molecular and image-based investigations have been developed. Diverse treatments are used, but there is a limited medical evidence to differentiate their effectiveness. We designed an international registry that would collect diagnostic, treatment and outcomes data, to establish new evidence for the management of this cancer. METHODS AND ANALYSIS The International Vitreoretinal B-Cell Lymphoma Registry will accrue data retrospectively for individuals aged 18 years or older, diagnosed with new or recurrent vitreoretinal B-cell lymphoma on or after 1 January 2020. A steering committee of subspecialised ophthalmologists identified 20 key clinical data items that describe patient demographics, tissue involvements, diagnostic testing, ocular and systemic treatments and treatment complications, and visual acuity and survival outcomes. Customised software was designed to permit collection of these data across a single baseline and multiple follow-up forms. The platform collects data without identifiers and at 3 month reporting intervals. Outcomes of the project will include: (1) descriptions of clinical presentations, and diagnostic and therapeutic preferences; (2) associations between clinical presentations, and diagnostics and treatments, and between diagnostics and treatments (assessed by ORs with 95% CIs); and (3) estimations of rates of vision loss, and progression-free and overall survival (assessed by Kaplan-Meier estimates). ETHICS AND DISSEMINATION The registry has received Australia-wide approval by a national human research ethics committee. Sites located outside Australia are required to seek local human research ethics review. Results generated through the registry will be disseminated primarily by peer-reviewed publications that are expected to inform clinical practice, as well as educational materials.
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Affiliation(s)
- Justine R Smith
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Queensland Eye Institute, Brisbane, Queensland, Australia
| | - Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Janet L Davis
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida, USA
| | - Joke H de Boer
- Department of Ophthalmology, University Hospital Utrecht, Utrecht, The Netherlands
| | - Anthony J Hall
- Department of Ophthalmology, Alfred Health, Melbourne, Victoria, Australia
| | - Manabu Mochizuki
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Hiroshi Takase
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Valérie Touitou
- Department of Ophthalmology, Sorbonne University, Hospital Pitié Salpêtrière, Paris, France
| | | | - David J Wilson
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Steven Yeh
- Cancer Immunology Research Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark H B Radford
- Queensland Eye Institute, Brisbane, Queensland, Australia
- Faculty of Medicine, George E Palade University of Medicine, Pharmacy, Science and Technology, Târgu Mureș, Romania
- Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Therssen S, Meers S, Jacob J, Schauwvlieghe PP. Brentuximab vedotin induced uveitis. Am J Ophthalmol Case Rep 2022; 26:101440. [PMID: 35243175 PMCID: PMC8885609 DOI: 10.1016/j.ajoc.2022.101440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a case of bilateral Vogt-Koyanagi-Harada (VKH)-like granulomatous pan uveitis secondary to brentuximab vedotin (BV) administration to treat for classical Hodgkin lymphoma (CHL). Observations A case of bilateral pan uveitis is described, following administration of BV, with features of VKH-like uveitis: presence of inflammatory cells in the anterior and posterior segment, multiple small serous detachments around the optic disc and retinal pigment epithelium (RPE) folds confirmed by optical coherence tomography (OCT) as well as hypocyanesent dark dots, disc hyperfluorescence and fuzzy vascular patterns seen on indocyanine green and fluorescein angiography. There were no systemic features of VKH disease. Further etiological investigation showed no clear infectious or inflammatory cause. The uveitis responded well to treatment with corticosteroids and cessation of BV. A relapse occurred a few months later when BV treatment was reinitiated, suggesting a probable adverse event to this drug, according to the Naranjo algorithm. Conclusions We hypothesize that administration of BV can induce a VKH-like uveitis, caused by loss of function of protective CD30+ cells present in the uveal tract, possibly aggravated by collateral damage to surrounding CD30−cells and melanocytes, leading to a uveal immune reaction. It is therefore important for the clinicians using BV to be aware of this adverse event. Growing experience with immunotherapy will provide more clinical insights in these complex immune mechanisms in the future.
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Bernier R, Gavoille A, Chirpaz N, Jamilloux Y, Kodjikian L, Mathis T, Sève P. Diagnostic value of lumbar puncture for the etiological assessment of uveitis: a retrospective cohort of 188 patients. Graefes Arch Clin Exp Ophthalmol 2022; 260:1651-1662. [PMID: 34988612 DOI: 10.1007/s00417-021-05514-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
AIM To assess the relevance of lumbar puncture (LP) for the etiological diagnosis of uveitis and to establish predictive factors associated with its contributory use. METHODS We performed a retrospective study of patients with de novo uveitis who were referred to our tertiary hospital for etiological diagnosis of uveitis, between January 2003 and July 2018. We included patients who underwent a LP as part of the etiological assessment of uveitis. LP was considered as contributory if it led to the etiological diagnosis or to correct the initially suspected diagnosis. RESULTS One hundred eighty eight of the 1211 patients referred for evaluation (16%) had an LP, among these patients, 93 (49.4%) had abnormal results including 69 (36.7%) patients with hypercellularity, 69 (36.7%) with hyperproteinorachia, and 28 (14.9%) with oligoclonal bands and/or increased IgG index. LP was considered as contributing to the diagnosis in only 31 (16.4%) cases, among which there were 10 (5.3%) contributions to the etiological diagnosis and 21 (11.2%) modifications in the diagnosis classification. Multivariate analysis established that African ethnicity (p < 0.001), bilateral uveitis (p = 0.01), presence of macular edema or retinal serous detachment (p = 0.048), presence of retinal vasculitis (p < 0.001), presence of neurological signs or symptoms (p = 0.01), and contributing cerebral MRI (p < 0.001) were all significantly associated with a contributory LP. LP did not lead to any therapeutic modification. CONCLUSION LP direct contribution to the diagnosis was rare and most often detected non-specific abnormalities. LP should be performed only in cases of neurological clinical signs or symptoms, suspicion of multiple sclerosis, Vogt-Koyanagi-Harada, or syphilis.
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Affiliation(s)
- R Bernier
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, F-69004, Lyon, France.,Department of Ophthalmology, Croix-Rousse Teaching Hospital, Hospices Civils de Lyon, , Lyon, France
| | - A Gavoille
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, F-69004, Lyon, France
| | - N Chirpaz
- Department of Ophthalmology, Croix-Rousse Teaching Hospital, Hospices Civils de Lyon, , Lyon, France
| | - Y Jamilloux
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, F-69004, Lyon, France
| | - L Kodjikian
- Department of Ophthalmology, Croix-Rousse Teaching Hospital, Hospices Civils de Lyon, , Lyon, France.,UMR-CNRS 5510 Matéis, Villeurbanne, Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
| | - T Mathis
- Department of Ophthalmology, Croix-Rousse Teaching Hospital, Hospices Civils de Lyon, , Lyon, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, F-69004, Lyon, France. .,Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
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9
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Kaya M, Öner FH, Lebe B, Özkal S, Men S, Saatci AO. Challenges in the Diagnosis of Intraocular Lymphoma. Turk J Ophthalmol 2021; 51:317-325. [PMID: 34702874 PMCID: PMC8558694 DOI: 10.4274/tjo.galenos.2021.50607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Intraocular lymphomas are among the rare malignancies that present with a wide variety of clinical manifestations. Differential diagnosis can be very troublesome due to its mimicking nature, insidious disease onset, and partial treatment response to steroids. The most important step in diagnosis is a high index of suspicion. Signs of the disease are now easier to detect using multimodal imaging techniques. In this case series, we reviewed the clinical characteristics of two women aged 70 and 71 years and a 72-year-old man with intraocular lymphoma and described their multimodal imaging findings in detail. Bilateral eye involvement was present in all three cases at our first ophthalmological examination. While the disease first presented with ocular involvement in two of the three cases, ocular involvement was detected seven years after initial heart involvement in one patient. All three patients had diffuse large B-cell lymphomas (one diagnosed with retinal biopsy, one with conjunctival biopsy, and the remaining with stereotactic brain biopsy). Intraocular lymphoma should be diagnosed and treated using a multidisciplinary approach, and we share our experience in this case series.
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Affiliation(s)
- Mahmut Kaya
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Ferit Hakan Öner
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
| | - Banu Lebe
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Sermin Özkal
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Süleyman Men
- Dokuz Eylül University Faculty of Medicine, Department of Radiology, İzmir, Turkey
| | - Ali Osman Saatci
- Dokuz Eylül University Faculty of Medicine, Department of Ophthalmology, İzmir, Turkey
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Sobolewska B, Chee SP, Zaguia F, Goldstein DA, Smith JR, Fend F, Mochizuki M, Zierhut M. Vitreoretinal Lymphoma. Cancers (Basel) 2021; 13:3921. [PMID: 34439078 PMCID: PMC8394064 DOI: 10.3390/cancers13163921] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
Vitreoretinal lymphoma (VRL) is a rare variant of primary central nervous system lymphoma (PCNSL), mostly of diffuse large B cell lymphoma, which affects the retina and/or the vitreous with or without optic nerve involvement. The disease course is aggressive. Up to 90% of the patients develop central nervous system lymphoma within one year. The diagnosis of VRL is challenging due to nonspecific chronic and relapsing uveitis and is made by anterior chamber tab or vitreous aspirate biopsy. There is no established treatment protocol for VRL patients with bilateral involvement without CNS involvement. There are suggestions to use only intravitreal chemotherapy with methotrexate and/or rituximab. Alternatively, systemic high-dose MTX treatment or external beam radiotherapy is used. Further studies are needed to prove and confirm the prophylactic systemic therapy in preventing CNS involvement in limited VRL.
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Affiliation(s)
- Bianka Sobolewska
- Center of Ophthalmology, University of Tuebingen, 72076 Tuebingen, Germany;
| | - Soon-Phaik Chee
- Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore;
- Singapore Eye Research Institute, 11 Third Hospital Avenue, Singapore 168751, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 168751, Singapore
- Duke-NUS Medical School, Singapore 168751, Singapore
| | - Fatma Zaguia
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (F.Z.); (D.A.G.)
| | - Debra Anne Goldstein
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (F.Z.); (D.A.G.)
| | - Justine R. Smith
- College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia;
| | - Falko Fend
- Institute for Pathology and Neuropathology, University of Tuebingen, 72076 Tuebingen, Germany;
| | | | - Manfred Zierhut
- Center of Ophthalmology, University of Tuebingen, 72076 Tuebingen, Germany;
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11
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Carbonell D, Mahajan S, Chee SP, Sobolewska B, Agrawal R, Bülow T, Gupta V, Jones NP, Accorinti M, Agarwal M, Batchelor T, Biswas J, Cimino L, tenDam-van Loon NH, de-la-Torre A, Frenkel S, Pe'er J, Kramer M, Miserocchi E, Mochizuki M, Ness T, Rosenbaum JT, Sen HN, Simion M, Sitter H, Vasconcelos-Santos DV, Habot-Wilner Z, Coupland SE, Pulido JS, Smith J, Thorne JE, Zierhut M. Consensus Recommendations for the Diagnosis of Vitreoretinal Lymphoma. Ocul Immunol Inflamm 2021; 29:507-520. [PMID: 34009095 DOI: 10.1080/09273948.2021.1878233] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To provide recommendations for diagnosis of vitreoretinal lymphoma (VRL). METHODS Literature was reviewed for reports supporting the diagnosis of VRL. A questionnaire (Delphi 1 round) was distributed to 28 participants. In the second round (Delphi 2), items of the questionnaire not reaching consensus (75% agreement) were discussed to finalize the recommendations. RESULTS Presenting symptoms include floaters and painless loss of vision, vitreous cells organized into sheets or clumps. Retinal lesions are usually multifocal creamy/white in the outer retina. Other findings include retinal lesions with "leopard-skin" appearance and retinal pigment epithelium atrophy. Severe vitreous infiltration without macular edema is the most likely presentation. Diagnostic vitrectomy should be performed. Systemic corticosteroid should be discontinued at least 2 weeks before surgery. An interleukin (IL)-10:IL-6 ratio > 1, positive mutation for the myeloid differentiation primary response 88 gene and monoclonality are indicators of VRL. Multi-modal imaging (optical coherence tomography, fundus autofluorescence) are recommended. CONCLUSIONS A consensus meeting allowed the establishment of recommendations important for the diagnosis of VRL.
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Affiliation(s)
- Denise Carbonell
- Ocular Inflammation and Immunology section, Singapore National Eye Centre, Singapore
| | | | - Soon-Phaik Chee
- Ocular Inflammation and Immunology section, Singapore National Eye Centre, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Singapore Eye Research Institute, The Academia, Singapore.,Department of Ophthalmology & Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Bianka Sobolewska
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Rupesh Agrawal
- Department of Ophthalmology, National Healthcare Group Eye Institute, Singapore
| | - Tanja Bülow
- Department of Medical Statistics, RWTH Aachen University, Aachen, Germany
| | - Vishali Gupta
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nicholas P Jones
- Uveitis service, Manchester Royal Eye Hospital, Manchester; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Massimo Accorinti
- Department of Ophthalmology, Sapienza University of Rome, Rome, Italy
| | | | - Tracy Batchelor
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts , United States
| | | | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS, Di Reggio Emilia, Italy
| | | | - Alejandra de-la-Torre
- NeURos Research Group, Escuela De Medicina Y Ciencias De La Salud, Universidad Del Rosario, Bogotá, Colombia
| | - Shahar Frenkel
- Department Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Pe'er
- Department Division of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Michal Kramer
- Uveitis service, Department of Ophthamology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Elisabetta Miserocchi
- Ocular Immunology and Uveitis Service, University Hospital San Raffaele Milan, Milan, Italy
| | - Manabu Mochizuki
- Department of Ophthalmology & Visual Science Tokyo Medical and Dental University Graduate School, Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan
| | - Thomas Ness
- Department of Ophthalmology, University Eye Clinic Freiburg, Freiburg, Germany
| | - James T Rosenbaum
- Uveitis Section, Oregon Health & Science and University Casey Eye Institute, Portland, Oregon, USA
| | - H Nida Sen
- Uveitis Clinic, National Eye Institute, Bethesda, Maryland, USA
| | | | - Helmut Sitter
- Institute of Surgical Research, Dept. Of Medicine, Philipps-University Marburg, Marburg, Germany
| | | | - Zohar Habot-Wilner
- Division of Ophthalmology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Sarah E Coupland
- Pathology Department, Liverpool Clinical Laboratories, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - José S Pulido
- Departments of Ophthalmology and Molecular Medicine, Mayo Clinic, Philadelphia, Pennsylvania, USA
| | - Justine Smith
- Eye and Vision Health section, Flinders University College of Medicine and Public Health, Adelaide, Australia
| | - Jennifer E Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manfred Zierhut
- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
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- Centre of Ophthalmology, University of Tuebingen, Tuebingen, Germany
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12
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A novel OCT signature in leukemic papillopathy masquerading as autoimmune or infectious uveitis. Graefes Arch Clin Exp Ophthalmol 2021; 259:1315-1322. [PMID: 33394161 DOI: 10.1007/s00417-020-05055-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE With therapeutic advances, central nervous system (CNS) involvement in leukemia has become more common. Leukemic optic disc infiltration, often a clinical diagnosis, can present as an isolated finding in primary or relapsed CNS disease and therefore requires early recognition. Not previously well appreciated, we report here signs of intraocular inflammation accompanying leukemic optic disc infiltration, suggesting infectious or non-infectious uveitis as an alternative diagnosis. We describe a novel optical coherence tomography (OCT) sign favoring leukemic infiltration. METHODS Retrospective consecutive case series of all leukemic patients with disc edema (5 patients, 6 eyes) presenting to the University of Michigan's Ocular Oncology Clinic between October 2019 and March 2020. RESULTS We report five leukemic patients (6 eyes) who were evaluated for disc edema and vitritis and eventually diagnosed with leukemic papillopathy. All five patients initially had a bland lumbar puncture (LP), and all four patients who underwent magnetic resonance imaging (MRI) had no retrobulbar nerve involvement. Clinical findings included preserved visual acuity (n = 5 eyes, 83%), anterior chamber (AC) cell (n = 3 eyes, 50%), vitreous cell (n = 6 eyes, 100%), and retinal whitening (n = 4 eyes, 66%). In five eyes (83%), a diagnosis of infectious or non-infectious uveitis was initially considered. The OCT finding of inner retinal thickening and loss of inner retinal lamination with largely preserved outer retinal architecture helped point towards a leukemic infiltrative process emanating from the disc and spreading retrograde through the nerve fiber layer. CONCLUSIONS These cases highlight the difficulty of distinguishing intraocular inflammation associated with leukemic papillopathy from infectious or non-infectious uveitis, especially considering bland LP and negative retrobulbar MRI signal in all our patients. We propose juxtapapillary inner retinal infiltration with the loss of inner retinal lamination and relative preservation of outer retinal architecture on OCT imaging as a finding that supports the diagnosis of leukemic papillopathy.
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Farrall AL, Smith JR. Eye involvement in primary central nervous system lymphoma. Surv Ophthalmol 2020; 65:548-561. [PMID: 32057762 DOI: 10.1016/j.survophthal.2020.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/18/2022]
Abstract
Primary central nervous system lymphoma (PCNSL) may manifest initially in the eye (termed vitreoretinal lymphoma or VRL) or in non-ocular CNS compartments, or in both. The nature of the onset of PCNSL implies two clinical specialists - ophthalmologists and neuro-oncologists - independently may assess the primary presentation of this rare malignancy. Clinically relevant perspectives on expectations of PCNSL manifestation in both ocular and non-ocular CNS compartments would help inform management practices in each specialty, which should impact clinical outcomes. A recent increase in the number of published PCNSL cohort studies provides new opportunity to review the current prevalence rates of ocular involvement, and the timing of this involvement over the course of disease. In PCNSL cohorts defined by non-ocular CNS compartment involvement, with or without ocular involvement (termed "PCNSL ± ocular involvement" cohorts), mean rates of concomitant VRL at diagnosis, or at any time during the course, are 10% and 16%, respectively. Only a few individuals within this cohort group present with exclusive eye disease (<5%), and the rate of secondary ocular involvement is only 5-9%. In PCNSL cohorts defined by the involvement of the ocular compartment, with or without non-ocular CNS involvement (termed "VRL ± non-ocular CNS involvement" cohorts), 58% of persons have a primary ocular diagnosis, which carries a 50% risk of secondary involvement in the CNS beyond the eye. Rates of non-ocular CNS involvement with VRL at diagnosis or over the course of disease are 41% and 69%, respectively.
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Affiliation(s)
- Alexandra L Farrall
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
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14
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Kuo DE, Wei MM, Knickelbein JE, Armbrust KR, Yeung IYL, Lee AY, Chan CC, Sen HN. Logistic Regression Classification of Primary Vitreoretinal Lymphoma versus Uveitis by Interleukin 6 and Interleukin 10 Levels. Ophthalmology 2020; 127:956-962. [PMID: 32197914 DOI: 10.1016/j.ophtha.2020.01.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE To assess the diagnostic performance and generalizability of logistic regression in classifying primary vitreoretinal lymphoma (PVRL) versus uveitis from intraocular cytokine levels in a single-center retrospective cohort, comparing a logistic regression model and previously published Interleukin Score for Intraocular Lymphoma Diagnosis (ISOLD) scores against the interleukin 10 (IL-10)-to-interleukin 6 (IL-6) ratio. DESIGN Retrospective cohort study. PARTICIPANTS Patient histories, pathology reports, and intraocular cytokine levels from 2339 patient entries in the National Eye Institute Histopathology Core database. METHODS Patient diagnoses of PVRL versus uveitis and associated aqueous or vitreous IL-6 and IL-10 levels were collected retrospectively. From these data, cytokine levels were compared between diagnoses with the Mann-Whitney U test. A logistic regression model was trained to classify PVRL versus uveitis from aqueous and vitreous IL-6 and IL-10 samples and compared with ISOLD scores and IL-10-to-IL-6 ratios. MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve (AUC) for each classifier and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) at the optimal cutoff (maximal Youden index) for each classifier. RESULTS Seventy-seven lymphoma patients (10 aqueous samples, 67 vitreous samples) and 84 uveitis patients (19 aqueous samples, 65 vitreous samples) treated between October 5, 1999, and September 16, 2015, were included. Interleukin 6 levels were higher and IL-10 levels were lower in uveitis patients compared with lymphoma patients (P < 0.01). For vitreous samples, the logistic regression model, ISOLD score, and IL-10-to-IL-6 ratio achieved AUCs of 98.3%, 97.7%, and 96.3%, respectively. Sensitivity, specificity, PPV, and NPV at the optimal cutoffs for each classifier were 94.2%, 96.9%, 97%, and 94% for the logistic regression model; 92.7%, 100%, 100%, and 92.9% for the ISOLD score; and 94.2%, 95.3%, 95.6%, and 93.9% for the IL-10-to-IL-6 ratio. All models achieved complete separation between uveitis and lymphoma in the aqueous data set. CONCLUSIONS The accuracy of the logistic regression model and generalizability of the ISOLD score to an independent patient cohort suggest that intraocular cytokine analysis by logistic regression may be a promising adjunct to cytopathologic analysis, the gold standard, for the early diagnosis of primary vitreoretinal lymphoma. Further validation studies are merited.
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Affiliation(s)
- David E Kuo
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland; Shiley Eye Institute, University of California, San Diego, La Jolla, California
| | - Maggie M Wei
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland; Krieger Eye Institute, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Jared E Knickelbein
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Karen R Armbrust
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Ian Y L Yeung
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland; Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Chi-Chao Chan
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - H Nida Sen
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland.
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15
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Zhao XY, Xia S, Chen YX. ROLE OF DIAGNOSTIC PARS PLANA VITRECTOMY IN DETERMINING THE ETIOLOGY OF UVEITIS INITIALLY UNKNOWN. Retina 2020; 40:359-369. [PMID: 31972807 DOI: 10.1097/iae.0000000000002372] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To estimate the success and safety of diagnostic pars plana vitrectomy (PPV) in determining the etiology of uveitis initially unknown and analyze their characteristics. METHODS The PubMed, Embase, and Ovid were searched up to October 2017 to identify relevant studies. The PRISMA guidelines were followed. Statistical analyses were performed with R version 3.3.1. Result in proportion were transformed by the Freeman-Tukey variant of arcsine square to attain symmetry of confidence intervals (CIs). The statistical heterogeneity was assessed by the chi-square test and I statistics. Sensitivity analysis and subgroup analyses were performed to identify the source of heterogeneity. Publication bias was assessed by the Egger test. RESULTS Sixteen studies involving 1,195 patients were finally included. The pooling result showed the successful rate of diagnostic PPV was 44% (95% CI [39%∼50%]). Among patients whose diagnostic PPV yielded a definitive diagnosis, 69% were infectious uveitis (95% CI [61%∼77%]), 23% were lymphoma (95% CI [17%∼30%]), and 4% were metastatic carcinoma (95% CI [2%∼10%]). Among patients diagnosed with infectious uveitis, the most frequent pathogens identified were viruses, followed by bacteria, Toxocara canis, Toxoplasma gondii, tuberculosis, and fungus. The incidence of postoperative cataract and postoperative retinal detachment was 19% (95% CI [8%∼29%]) and 5% (95% CI [1%∼10%]), respectively, and the rate of secondary vitrectomy surgery was 10% (95% CI [2%∼22%]). Postoperative visual improvement rate was 46% (95% CI [39%∼52%]), and the postoperative treatment strategy was changed in light of the results of diagnostic PPV in 20% of cases (95% CI [10%∼29%]). CONCLUSION For uveitis of unknown cause, diagnostic PPV is an effective, reliable, and relatively safe procedure for establishing the definite diagnosis and guiding further treatment. Positive therapeutic effect could also be achieved.
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Affiliation(s)
- Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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16
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Kvopka M, Lake SR, Smith JR. Intraocular chemotherapy for vitreoretinal lymphoma: A review. Clin Exp Ophthalmol 2019; 48:240-248. [DOI: 10.1111/ceo.13668] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Michael Kvopka
- Flinders University College of Medicine and Public Health Adelaide South Australia Australia
| | - Stewart R. Lake
- Ophthalmology Unit – Division of Surgery, Flinders Medical Centre Adelaide South Australia Australia
| | - Justine R. Smith
- Flinders University College of Medicine and Public Health Adelaide South Australia Australia
- Ophthalmology Unit – Division of Surgery, Flinders Medical Centre Adelaide South Australia Australia
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17
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Intraocular Biopsy and ImmunoMolecular Pathology for "Unmasking" Intraocular Inflammatory Diseases. J Clin Med 2019; 8:jcm8101733. [PMID: 31635036 PMCID: PMC6832563 DOI: 10.3390/jcm8101733] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/05/2019] [Accepted: 10/15/2019] [Indexed: 12/15/2022] Open
Abstract
Intraocular inflammation can hide a variety of eye pathologies. In 33% of cases, to obtain a correct diagnosis, investigation of the intraocular sample is necessary. The combined analyses of the intraocular biopsy, using immuno-pathology and molecular biology, point to resolve the diagnostic dilemmas in those cases where history, clinical tests, and ophthalmic and systemic examinations are inconclusive. In such situations, the teamwork between the ophthalmologist and the molecular pathologist is critically important to discriminate between autoimmune diseases, infections, and intraocular tumors, including lymphoma and metastases, especially in those clinical settings known as masquerade syndromes. This comprehensive review focuses on the diagnostic use of intraocular biopsy and highlights its potential to enhance research in the field. It describes the different surgical techniques of obtaining the biopsy, risks, and complication rates. The review is organized according to the anatomical site of the sample: I. anterior chamber containing aqueous humor, II. iris and ciliary body, III. vitreous, and IV. choroid and retina. We have excluded the literature concerning biopsy for choroidal melanoma and retinoblastoma, as this is a specialized area more relevant to ocular oncology.
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18
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Touitou V, Costopoulos M, Maloum K. Detection ofMYD88Mutations in Vitreoretinal Lymphoma and Its Implications. JAMA Ophthalmol 2018; 136:1104-1105. [DOI: 10.1001/jamaophthalmol.2018.2894] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Valerie Touitou
- Department of Ophthalmology, Pitie Salpetriere Hospital, Paris, France
- Sorbonne Universities, Paris, France
| | - Myrto Costopoulos
- Sorbonne Universities, Paris, France
- Department of Biological Haematology, Pitie Salpetriere Hospital, Paris, France
- INSERM U1138, Programmed Cell Death and Physiopathology of Tumor Cells, Team 19, Centre de Recherche des Cordeliers, Paris, France
| | - Karim Maloum
- Department of Biological Haematology, Pitie Salpetriere Hospital, Paris, France
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19
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Dawson AC, Williams KA, Appukuttan B, Smith JR. Emerging diagnostic tests for vitreoretinal lymphoma: a review. Clin Exp Ophthalmol 2018; 46:945-954. [DOI: 10.1111/ceo.13304] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/13/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Abby C Dawson
- Eye and Vision Health Flinders University College of Medicine and Public Health Adelaide South Australia Australia
| | - Keryn A Williams
- Eye and Vision Health Flinders University College of Medicine and Public Health Adelaide South Australia Australia
| | - Binoy Appukuttan
- Eye and Vision Health Flinders University College of Medicine and Public Health Adelaide South Australia Australia
| | - Justine R Smith
- Eye and Vision Health Flinders University College of Medicine and Public Health Adelaide South Australia Australia
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Cimino L, Coassin M, Chan CC, Marchi S, Belpoliti M, Fanti A, Iovieno A, Fontana L. Vitreoretinal lymphomas misdiagnosed as uveitis: Lessons learned from a case series. Indian J Ophthalmol 2016; 64:369-75. [PMID: 27380976 PMCID: PMC4966374 DOI: 10.4103/0301-4738.185600] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 04/28/2016] [Indexed: 11/14/2022] Open
Abstract
PURPOSE To present challenging cases of vitreoretinal lymphoma (VRL) that was misdiagnosed as uveitis because of the apparent intraocular inflammation. At the light of the new classification of intraocular lymphomas, we detail the characteristics that masqueraded the tumors and the clinical aspects that guided us to the correct diagnosis. MATERIALS AND METHODS We retrospectively reviewed the patients referred to our uveitis service between January 2006 and December 2014. RESULTS Seven patients referred with a presumptive diagnosis of idiopathic uveitis received a final diagnosis of VRL. The median time between the onset of symptoms and definitive diagnosis was 25 months for these complex cases. The median time from presentation at our clinic to final diagnosis was 1 month. The described clinical features including dense vitreous cells and subretinal infiltrates were characteristic and tend to be present in all these chronically ill patients. Vitreous samples were collected, and all demonstrated the pathognomonic tumor cells, the specific immunoglobulin heavy chain gene rearrangements, and an interleukin (IL)-10 to IL-6 ratio >1. CONCLUSION VRLs are severe diseases with a poor prognosis that may be misdiagnosed as idiopathic inflammatory conditions of the eye. Treatment with steroids may occult the tumors and delay the correct diagnosis. Appropriate evaluation may prompt to a timely vitreous sampling and therefore to a faster diagnosis in these peculiar cases where the correct diagnosis was delayed by several months.
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Affiliation(s)
- Luca Cimino
- Department of Ophthalmology, Uveitis Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Marco Coassin
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Chi-Chao Chan
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sylvia Marchi
- Department of Ophthalmology, Uveitis Service, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Matteo Belpoliti
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Andrea Fanti
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Alfonso Iovieno
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Luigi Fontana
- Department of Ophthalmology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
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21
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Mastropasqua R, Thaung C, Pavesio C, Lightman S, Westcott M, Okhravi N, Aylward W, Charteris D, da Cruz L. The Role of Chorioretinal Biopsy in the Diagnosis of Intraocular Lymphoma. Am J Ophthalmol 2015; 160:1127-1132.e1. [PMID: 26344582 DOI: 10.1016/j.ajo.2015.08.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the clinical usefulness of chorioretinal biopsy in establishing a definitive diagnosis in intraocular lymphomas. DESIGN Retrospective, noncomparative, consecutive diagnostic case series. METHODS setting: Moorfields Eye Hospital, London, United Kingdom. PATIENTS Twenty-nine consecutive patients presenting with severe uveitis that required an intraocular biopsy where underlying lymphoma was suspected. OBSERVATION PROCEDURE A retrospective review of a 15-year period (1999-2014) was undertaken of all patients that have undergone chorioretinal biopsy for suspected lymphoma at Moorfields Eye Hospital, London, United Kingdom. Patients were identified on the hospital's computerized database. MAIN OUTCOME MEASURES Effectiveness of chorioretinal biopsy in establishing a definitive diagnosis or in excluding malignancy. RESULTS A specific histologic diagnosis was made in 17 cases (59%) while in 9 cases the biopsy combined with clinical data was effective in excluding malignancy. In the 3 remaining cases, no specific diagnosis was made. No intraoperative complications were reported. Postoperative complications other than cataract included 2 vitreous hemorrhages and 2 retinal detachments. Of the 17 cases with a histologic diagnosis, 15 were obtained in eyes with marked vitritis, as opposed to 2 with minimal vitritis. CONCLUSIONS Chorioretinal biopsy provided a definitive diagnosis of lymphoma in 59% of cases and assisted in exclusion of a further 31% in this series. The level of vitritis appears to act as a strong index of likelihood in achieving a definitive histologic diagnosis.
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