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

  • Adrienne W. Scott
  • Prithvi Mruthyunjaya
  • Rex M. McCallum
  • Glenn J. Jaffe
Inflammatory Disorders

Abstract

Purpose

Diagnostic vitrectomy is frequently used to help establish a diagnosis in challenging uveitis cases. The usefulness of this procedure in patients with suspected sarcoidosis with posterior segment involvement, in whom a diagnosis cannot be determined by conventional methods, has not been well-described. We hypothesized that diagnostic vitrectomy would help establish a diagnosis of presumed sarcoidosis-related posterior segment inflammation in these challenging cases, and evaluated the diagnostic yield of vitreous biopsy in these eyes.

Design

Retrospective interventional case series.

Methods

Diagnostic vitrectomy was performed on eyes with intermediate, posterior, or panuveitis in which an etiology could not be characterized by history, clinical examination, ancillary testing, and/or laboratory testing. Retrospective chart review was conducted on consecutive eyes that underwent diagnostic, or diagnostic and therapeutic vitrectomy by a single surgeon between January 1989 and June 2006.

Results

Diagnostic and therapeutic vitrectomy was performed on 150 eyes. The final diagnosis was established by positive vitreous fluid analysis in 63 eyes (42 %). Eight of these vitreous specimens (5.3 %) yielded cytopathology consistent with presumed sarcoidosis-related posterior segment inflammation.

Conclusions

Sarcoidosis can cause characteristic inflammatory changes in the vitreous. In the appropriate clinical setting, cytopathologic assessment of these inflammatory changes observed in vitreous specimens can support the diagnosis of presumed sarcoidosis-related posterior segment inflammation, and help direct clinical management.

Keywords

Sarcoid-related inflammation Vitreous biopsy Diagnostic vitrectomy Ocular sarcoidosis 

Notes

Acknowledgements

This work received no external funding. The authors have no competing financial interests in this work. This study was approved by the Duke University Institutional Review Board, protocol ID #9351-07-1R0ER.

This trial has been registered with ClinicalTrials.gov. The registry number is NCT00609687.

References

  1. 1.
    Newman LS, Rose CS, Maier LA (1997) Sarcoidosis. N Engl J Med 336:1224–1234PubMedCrossRefGoogle Scholar
  2. 2.
    Rothova A (2000) Ocular involvement in sarcoidosis. Br J Ophthalmol 84:110–116PubMedCrossRefGoogle Scholar
  3. 3.
    Bonfioli AA, Orefice F (2005) Sarcoidosis. Semin Ophthalmol 20:177–182PubMedCrossRefGoogle Scholar
  4. 4.
    Jones NP (2002) Sarcoidosis and uveitis. Ophthalmol Clin North Am 15:319–326PubMedCrossRefGoogle Scholar
  5. 5.
    Wu JJ (2004) Sarcoidosis. Am Fam Physician 70:312–322PubMedGoogle Scholar
  6. 6.
    Smith JA, Foster CS (1996) Sarcoidosis and its ocular manifestations. Int Ophthalmol Clin 36:109–125PubMedCrossRefGoogle Scholar
  7. 7.
    Cowan CL Jr (2004) Sarcoidosis. In: Yanoff M, Duker JS (eds) Ophthalmology. Mosby, St. Louis, pp 1185–1190Google Scholar
  8. 8.
    Obenauf CD, Shaw HE, Sydnor CF, Klintworth GK (1978) Sarcoidosis and its ophthalmic manifestations. Am J Ophthalmol 86:648–655PubMedGoogle Scholar
  9. 9.
    Jabs DA, Johns CJ (1986) Ocular involvement in chronic sarcoidosis. Am J Ophthalmol 102:297–301PubMedGoogle Scholar
  10. 10.
    Dana MR, Merayo-Lloves J, Schaumberg DA, Foster CS (1996) Prognosticators for visual outcome in sarcoid uveitis. Ophthalmology 103:1846–1853PubMedGoogle Scholar
  11. 11.
    Bardelli AM, Barberi L, Vanni M, Mazzera L, Traversi C (1993) Eye involvement in sarcoidosis: survey of 197 patients. Sarcoidosis 10:158–159PubMedGoogle Scholar
  12. 12.
    Rothova A, Alberts C, Glasius E, Kijlstra A, Buitenhuis HJ, Breebaart AC (1989) Risk factors for ocular sarcoidosis. Doc Ophthalmol 72:287–296PubMedCrossRefGoogle Scholar
  13. 13.
    Bienfait MF, Baarsma GS (1986) Sixteen cases of uveitis associated with sarcoidosis. Int Ophthalmol 9:243–246PubMedCrossRefGoogle Scholar
  14. 14.
    Stavrou P, Linton S, Young DW, Murray PI (1997) Clinical diagnosis of ocular sarcoidosis. Eye 16:865–874Google Scholar
  15. 15.
    Khalatbari D, Stinnett S, McCallum RM, Jaffe GJ (2004) Demographic-related variations in posterior segment ocular sarcoidosis. Ophthalmology 111:357–362PubMedCrossRefGoogle Scholar
  16. 16.
    Rothova A, Suttorp-van Schulten MSA, Treffers WF, Kijlstra A (1996) Causes and frequency of blindness in patients with intraocular inflammatory disease. Br J Ophthalmol 80:332–336PubMedCrossRefGoogle Scholar
  17. 17.
    Priem H, Verbraeken H, De Laey JJ (1993) Diagnostic problems in chronic vitreous inflammation. Graefes Arch Clin Exp Ophthalmol 231:453–456PubMedCrossRefGoogle Scholar
  18. 18.
    Mruthyunjaya P, Jumper JM, McCallum R, Patel DJ, Cox TA, Jaffe GJ (2002) Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy. Ophthalmology 109:1123–1129PubMedCrossRefGoogle Scholar
  19. 19.
    Piro P, Pappas H, Erozan Y (1982) Diagnostic vitrectomy in metastatic breast carcinoma in the vitreous. Retina 2:182–188PubMedCrossRefGoogle Scholar
  20. 20.
    Char D, Margolis L, Newman A (1981) Ocular reticulum cell sarcoma. Am J Ophthalmol 91:480–483PubMedGoogle Scholar
  21. 21.
    Jaffe GJ (1998) Diagnostic vitrectomy. In: Guyer DR, Chang S, Yannuzi L (eds) Vitreous, retina, macula, vol 2. Saunders, Philadelphia, chap. 125Google Scholar
  22. 22.
    Montoya J, Parmley S, Liesenfeld O, Jaffe GJ, Remington JS (1999) Use of the polymerase chain reaction for diagnosis of ocular toxoplasmosis. Ophthalmology 106:1554–1563PubMedCrossRefGoogle Scholar
  23. 23.
    Davis J, Chan CC, Nussenblatt R (1992) Diagnostic vitrectomy in intermediate uveitis. Dev Ophthalmol 23:120–132PubMedGoogle Scholar
  24. 24.
    Uy HS, Foster CS (1999) Diagnostic vitrectomy and uveitis. Int Ophthalmol Clin 39:223–225PubMedCrossRefGoogle Scholar
  25. 25.
    Smith IL, Macdonald JC, Freeman WR, Shapiro AM, Spector SA (1999) Cytomegalovirus retinitis activity is accurately reflected by the presence and level of CMV DNA in aqueous humor and vitreous. J Infect Dis 179:1249–1253PubMedCrossRefGoogle Scholar
  26. 26.
    Hogan M, Kimura A, Thygeson P (1959) Signs and symptoms of uveitis I. Anterior uveitis. Am J Ophthalmol 47:155–170PubMedGoogle Scholar
  27. 27.
    Nussenblatt R, Palestine A, Chan CC, Roberge F (1985) Standardization of vitreal inflammatory activity in intermediate and posterior uveitis. Ophthalmology 92:467–471PubMedGoogle Scholar
  28. 28.
    Jaffe GJ (1993) Diagnostic vitrectomy in the management of ocular disease. Semin Ophthalmol 8:15–23PubMedCrossRefGoogle Scholar
  29. 29.
    Akpek EK, Ahmed I, Hochberg FH, Soheilian M, Dryja TP, Jakobiec FA, Foster CS (1999) Intraocular-central nervous system lymphoma: clinical features, diagnosis, and outcomes. Ophthalmology 106:1805–1810PubMedCrossRefGoogle Scholar
  30. 30.
    Liu K, Klintworth GK, Dodd LG (1999) Cytologic findings in vitreous fluids: analysis of 74 specimens. Acta Cytol 43:201–206PubMedCrossRefGoogle Scholar
  31. 31.
    Davis JL, Miller DM, Ruiz P (2005) Diagnostic testing of vitrectomy specimens. Am J Ophthalmol 140:822–829PubMedCrossRefGoogle Scholar
  32. 32.
    Verbraeken H (1996) Diagnostic vitrectomy and chronic uveitis. Graefes Arch Clin Exp Ophthalmol 234:S2–S7PubMedCrossRefGoogle Scholar
  33. 33.
    Carroll DM, Franklin RM (1981) Vitreous biopsy in uveitis of unknown cause. Retina 1:245–251PubMedCrossRefGoogle Scholar
  34. 34.
    Margolis R, Brasil OF, Lowder CY, Singh RP, Kaiser PK, Smith SD, Perez VL, Sonnie C, Sears JE (2007) Vitrectomy for the diagnosis and management of uveitis of unknown cause. Ophthalmology 114:1893–1897PubMedCrossRefGoogle Scholar
  35. 35.
    Kinoshita Y, Takasu K, Adachi Y, Yuri T, Matsunaga S, Nagumo S, Shikata N (2010) Diagnostic utility of vitreous humor fluid cytology for intraocular sarcoidosis: a clinicopathologic study of 7 cases. Diagn Cytopathol 40:210–213PubMedCrossRefGoogle Scholar
  36. 36.
    Rosen Y (2007) Pathology of sarcoidosis. Semin Respir Crit Care Med 28:36–52PubMedCrossRefGoogle Scholar
  37. 37.
    Dev S, McCallum RM, Jaffe GJ (1999) Methotrexate-treatment for sarcoid-associated panuveitis. Ophthalmology 106:111–118PubMedCrossRefGoogle Scholar
  38. 38.
    Herbort CP, Rao NA, Mochizuki M, members of Scientific Committee of First International Workshop on Ocular Sarcoidosis (2009) Ocul Immunol Inflamm 17:160–169PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Adrienne W. Scott
    • 1
    • 3
  • Prithvi Mruthyunjaya
    • 1
  • Rex M. McCallum
    • 2
  • Glenn J. Jaffe
    • 1
  1. 1.Department of Ophthalmology, Albert Eye Research InstituteDuke University Eye Center, Duke University Medical CenterDurhamUSA
  2. 2.Department of Medicine, Division of Rheumatology and Clinical ImmunologyDuke University Medical CenterDurhamUSA
  3. 3.Wilmer Eye InstituteJohns Hopkins University School of MedicineBaltimoreUSA

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