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Globočnik Petrovič M, Vrabič N, Prevodnik Kloboves V, Miceska S, Pajtler Rošar A, Vidovič Valentinčič N. SILICONE FINE-NEEDLE ASPIRATION RETINAL BIOPSY: A Novel Surgical Technique for Vitreoretinal Lymphoma. Retina 2024; 44:1590-1596. [PMID: 39167580 PMCID: PMC11332377 DOI: 10.1097/iae.0000000000004161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE To describe a 41-gauge silicone fine-needle aspiration biopsy (S-FNAB) technique and assess its value in diagnosing primary vitreoretinal lymphoma (PVRL). METHODS Retrospective review of seven consecutive patients who underwent vitreous biopsy (VB) and 41-gauge S-FNAB of retinal/subretinal lesions in a single tertiary center between January 2012 and March 2023. RESULTS Of seven patients, S-FNAB confirmed the diagnosis of PVRL in six patients. In five of those patients, both VB and retinal/subretinal S-FNAB (performed at the same procedure) yielded positive results, with the retinal thickness at the biopsy site as small as 231 µm. Four of these five patients had one or more previous negative VB. In one patient, S-FNAB yielded positive results despite a negative VB. Silicone fine-needle aspiration biopsy failed to confirm positive VB for PVRL in the remaining patient. The time from symptom onset to diagnosis of PVRL ranged from 18 days to 26 months. There were no severe complications associated with the procedure. CONCLUSION Silicone fine-needle aspiration biopsy might be a valuable method for obtaining a sufficient sample of viable cells to diagnose PVRL. It can be performed as a primary procedure along with VB. Further studies are warranted to determine where this technique could be most advantageous.
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Affiliation(s)
- Mojca Globočnik Petrovič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia;
| | - Nika Vrabič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia;
| | - Veronika Prevodnik Kloboves
- Department of Cytopathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; and
- Faculty of Medicine, University of Maribor, Maribor, Slovenia.
| | - Simona Miceska
- Department of Cytopathology, Institute of Oncology Ljubljana, Ljubljana, Slovenia; and
| | - Ana Pajtler Rošar
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia;
| | - Nataša Vidovič Valentinčič
- Eye Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia;
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Stoyukhina AS, Korobov EN, Smolin SA. [Isolated primary vitreoretinal lymphoma (case report)]. Vestn Oftalmol 2024; 140:94-101. [PMID: 38739137 DOI: 10.17116/oftalma202414002294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
This case report presents the diagnostic features of isolated primary intraocular lymphoma, which was initially misdiagnosed as neovascular age-related macular degeneration. A comprehensive examination using ultrasound, optical coherence tomography, and fundus autofluorescence revealed changes characteristic of vitreoretinal lymphoma. Molecular genetic analysis of the vitreous body showed the presence of a MYD88 gene mutation and B-cell clonality by immunoglobulin heavy chain (IGH) gene rearrangement tests, which confirmed the diagnosis.
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Affiliation(s)
- A S Stoyukhina
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - E N Korobov
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
| | - S A Smolin
- Krasnov Research Institute of Eye Diseases, Moscow, Russia
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3
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Lin ML, Hall AJ. Uveitis masquerade syndromes: An approach to diagnosis. Clin Exp Ophthalmol 2024; 52:91-105. [PMID: 37997019 DOI: 10.1111/ceo.14328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023]
Abstract
Uveitis masquerade syndromes are a diverse group of clinical entities which mimic conventional immune-mediated uveitis due to the presence of inflammatory signs but are resistant to anti-inflammatory therapy. Misdiagnosis hinders appropriate management in these conditions and may result in poor outcomes. This review discusses commonly encountered neoplastic and non-neoplastic disease processes that masquerade as intraocular inflammation with a focus on relevant clinical features and adjunctive investigations that are helpful in reaching a correct diagnosis.
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Affiliation(s)
- Ming Lee Lin
- Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anthony J Hall
- Alfred Health, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
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4
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Hébert M, You E, Touma S, Bourgault S, Hammamji K, Dirani A. Indications and pathologic diagnoses of diagnostic chorioretinal biopsies in the province of Quebec, Canada. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:491-497. [PMID: 35716703 DOI: 10.1016/j.jcjo.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/10/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To review the clinical usefulness of chorioretinal biopsies in diagnostically undefined cases of intraocular inflammation or chorioretinal lesions. DESIGN Retrospective case series. PARTICIPANTS Seven patients who underwent chorioretinal biopsies. METHODS This case series included all consecutive patients who underwent chorioretinal biopsies in 2 academic tertiary care centres in the province of Quebec between 2014 and 2020. RESULTS A total of 7 patients were included in the study. Five patients with intraocular inflammation underwent chorioretinal biopsies to rule out an infectious or neoplastic etiology, whereas 2 patients underwent biopsies for suspicion of neoplastic chorioretinal masses. Final diagnoses included primary chorioretinal lymphoma (n = 2), toxoplasmosis (n = 1), benign choroidal mass (n = 1), nonnecrotizing granuloma (n = 1), and peripheral exudative hemorrhagic chorioretinopathy (n = 1). No specific diagnosis was defined in 1 case of panuveitis with scleritis. No postoperative complications were reported. CONCLUSIONS Chorioretinal biopsies clarified the diagnosis in 6 of 7 patients, including a definitive diagnosis of lymphoma in 2 patients. This is a high rate of diagnosis that also represents clinically meaningful results that influence management. Future directions include identifying patients in whom adjuvant chorioretinal biopsy would yield a high rate of diagnosis.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada
| | - Eunice You
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada
| | - Samir Touma
- Department of Ophthalmology, Centre hospitalier universitaire de Montréal, Montreal, Qc, Canada
| | - Serge Bourgault
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada
| | - Karim Hammamji
- Department of Ophthalmology, Centre hospitalier universitaire de Montréal, Montreal, Qc, Canada
| | - Ali Dirani
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier Universitaire de Québec-Université Laval, Quebec City, Qc, Canada.
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Bansal R, Dogra M, Chawla R, Kumar A. Pars plana vitrectomy in uveitis in the era of microincision vitreous surgery. Indian J Ophthalmol 2021; 68:1844-1851. [PMID: 32823401 PMCID: PMC7690537 DOI: 10.4103/ijo.ijo_1625_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Pars plana vitrectomy (PPV) in uveitis is indicated for various diagnostic and therapeutic indications. With the advent of microincision vitreous surgery (MIVS), the use of PPV in uveitis has increased with a wider spectrum of indications due to shorter surgical time, less patient discomfort, less conjunctival scarring, and a decreased rate of complications as compared to standard 20G vitrectomy. Because of faster post-operative recovery in terms of visual improvement and reduction of inflammation, and reduced duration of systemic corticosteroids, MIVS has gained popularity in uveitis as an adjunctive therapy to the standard of care medical therapy. The safety and efficacy of MIVS is related to the emerging vitrectomy techniques with better and newer cutters, illuminating probes, and accessory instruments. Because of the instrumentation and fluidics of MIVS, PPV is emerging as a safe and useful alternative for diagnostic challenges in uveitis, aiding in earlier diagnosis and better outcome of inflammatory disease, even in the presence of severe and active inflammation, which was once considered a relative contraindication for performing vitreous surgery. However, for surgical interventions for therapeutic indications and complications of uveitis, it is advisable to achieve an optimum control of inflammation for best results. The increasing reports of the use of MIVS in uveitis have led to its wider acceptance among clinicians practicing uveitis.
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Affiliation(s)
- Reema Bansal
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Mohit Dogra
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohan Chawla
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Atul Kumar
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Abstract
An intraocular biopsy is performed for diagnostic, prognostic and investigational purposes. Biopsies help to confirm or exclude malignancies and differentiate inflammatory from infectious processes. Histopathological analysis is the final verdict in unresponsive uveitis, atypical inflammation, metastases and masquerade syndromes. Advances and refinement of techniques in cytopathology, immunohistochemistry, microbiological and molecular biologic study offer much more than just diagnosis. They provide prognosis based on cell characteristics and are helpful in planning treatment and intervention. Many biopsy procedures have evolved to provide more safety and minimise complications thus improving the quality of specimens or samples available for analysis. The type of biopsy and technique adopted varies based on the clinical suspicion, size and location of lesions. In uveitis, a working diagnosis of intraocular inflammation is made on clinical examination and laboratory investigations and ancillary tests. Malignancy and uveitis is interlinked and masquerade syndromes are among the commonest indications for biopsy and analysis of specimen. The various types of intraocular biopsies include aqueous tap, fine needle aspiration biopsy, vitreous biopsy, iris and ciliary body, and retinochoroidal biopsy. They will be reviewed in this article with respect to current perspective
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Affiliation(s)
- Gazal Patnaik
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, India
| | - Radha Annamalai
- Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, India
| | - Jyotirmay Biswas
- Medical Research Foundation, Sankara Nethralaya, 18, College Road, Chennai, India
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7
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Colombo L, Caretti A, Dei Cas M, Luciano F, Romano D, Paroni R, Patelli F, Ghidoni R, Rossetti L. Vitreous composition modification after transpalpebral electrical stimulation of the eye: Biochemical analysis. Exp Eye Res 2021; 207:108601. [PMID: 33910035 DOI: 10.1016/j.exer.2021.108601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/26/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023]
Abstract
Electrical stimulation (ES) of the eye represents a therapeutic approach in various clinical applications ranging from retinal dystrophies, age-related macular degeneration, retinal artery occlusion and nonarteritic ischemic optic neuropathy. In clinical practice, ES of the eye is mainly performed with a transcorneal or transpalpebral approach. These procedures are non-invasive and well-tolerated by the patients, reporting only minimal and transient adverse events, while serious adverse effects were not observed. Despite the growing literature on animal models, only clinical parameters have been investigated in humans and few data are available about biochemical changes induced by ES of the eye. The purpose of this study is to investigate the possible mechanism that regulates the beneficial effects of ES on retinal cells function and survival in humans. 28 patients undergoing pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (iERM) were randomly divided in two groups: 13 patients were treated with transpalpebral ES before surgery and 15 underwent surgery with no prior treatment. Vitreous samples were collected for biochemical analysis during PPV. ES treatment leads to a reduction in the vitreous expression of both proinflammatory cytokines, namely IL-6 and IL-8, and proinflammatory lipid mediators, such as lysophosphatidylcholine. Indeed, we observed a 70% decrease of lysophosphatidylcholine 18:0, which has been proven to exert the greatest proinflammatory activities among the lysophosphatidylcholine class. The content of triglycerides is also affected and significantly decreased following ES application. The vitreous composition of patients undergoing PPV for iERM displays significant changes following ES treatment. Proinflammatory cytokines and bioactive lipid mediators expression decreases, suggesting an overall anti-inflammatory potential of ES. The investigation of the mechanism by which this treatment alters the retinal neurons leading to good outcomes is essential for supporting ES therapeutic application in various types of retinal diseases.
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Affiliation(s)
- Leonardo Colombo
- Eye Clinic, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Anna Caretti
- Biochemistry and Molecular Biology Laboratory, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Michele Dei Cas
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.
| | - Francesco Luciano
- Biochemistry and Molecular Biology Laboratory, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Dario Romano
- Eye Clinic, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Rita Paroni
- Clinical Biochemistry and Mass Spectrometry Laboratory, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Fabio Patelli
- Eye Clinic, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Riccardo Ghidoni
- Biochemistry and Molecular Biology Laboratory, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Luca Rossetti
- Eye Clinic, ASST Santi Paolo e Carlo Hospital, Università degli Studi di Milano, Milan, Italy
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Abstract
Purpose: to summarize the origin and very recent history of the use of metagenomic sequencing for the diagnosis of infectious uveitis, convey the technique as described by one of the primary institutions experimenting with the technology, and present recent successful applications of the technology as well as potential advantages and pitfalls compared to other current diagnostic tools.Methods: review of peer-reviewed literature concerning metagenomic sequencing for the diagnosis of infectious uveitis.Conclusion: compared to existing diagnostic methods, metagenomic deep sequencing is a sensitive, unbiased, and comprehensive technique with great potential for diagnosing the causative pathogens of cases of infectious uveitis. However, many issues remain to be addressed in the process of developing this technology, including but not limited to the potentially overwhelming amount of information generated, definition of diagnostic thresholds, demonstration of validity, contamination, and cost.
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Affiliation(s)
- Lianna Valdes
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
| | - Paulo Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
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9
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Hanbazazh M, Dryja TP. Molecular Genetics of Intraocular Tumors. Semin Ophthalmol 2020; 35:174-181. [PMID: 32507011 DOI: 10.1080/08820538.2020.1776343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To explore the value of molecular technologies in the pathologic evaluation, diagnosis, and treatment of retinoblastoma and uveal melanoma. METHODS Review of the peer-reviewed literature on the molecular pathology of primary intraocular tumors. CONCLUSION Molecular tests are playing an increasingly important role in the diagnosis of intraocular tumors. They provide information valuable for diagnosis, prognosis, screening regimens, genetic counselling, and treatment. These technologies are becoming easier, faster, and with higher sensitivity and accuracy.
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Affiliation(s)
- Mehenaz Hanbazazh
- David G Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
| | - Thaddeus P Dryja
- David G Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, MA, USA
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