Skip to main content
SpringerLink
Log in

Diagnostic Biopsy in Uveitis

  • Chapter
  • First Online:
Uveitis

Part of the book series: Current Practices in Ophthalmology ((CUPROP))

  • 799 Accesses

Abstract

Elucidating the cause of uveitis is critical to evaluate for systemic disease and to determine treatment and prognosis. The diagnosis of various forms of uveitis is typically determined by a multitude of factors including patient history, clinical manifestations, course of uveitis, imaging, laboratory testing, and response to treatment. Unfortunately, most patients do not present with classic clinical findings and the underlying etiology is a diagnostic dilemma. While serologic diagnosis is limited to a few entities (such as syphilis), the diagnostic yield of systemic diagnostic testing for many infectious and malignant processes can be quite low. Obtaining a sample of aqueous, vitreous, or chorioretinal tissue can help make the diagnosis and guide therapy when there is suspicion for malignancy, infection, or inflammation that fails to respond to medical therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Yu HG, Kim TW. Diagnostic and therapeutic vitrectomy for uveitis. In: APWC S, Hinton DR, Sadda SR, Wiedemann P, editors. Ryan’s retina. Part 1, Section 5. New York: Elsevier; 2018.

    Google Scholar 

  2. Rhoades WR, Baldwin AJ, Nguyen QD, Do DV. Vitreous, retinal, and choroidal biopsy. In: Schachat APWC, Hinton DR, Sadda SR, Wiedemann P, editors. Ryan’s retina. Part 1, Section 5. New York: Elsevier; 2018. p. 2296–308.

    Google Scholar 

  3. Thomas AS, Flaxel CJ. Vitreoretinal surgery in uveitis. Int Ophthalmol Clin. 2015;55(2):67–79.

    Article  PubMed  Google Scholar 

  4. Park SS, D’Amico DJ, Foster CS. The role of invasive diagnostic testing in inflammatory eye diseases. Int Ophthalmol Clin. 1994;34(3):229–38.

    Article  CAS  PubMed  Google Scholar 

  5. Hunter RS, Lobo AM. Current diagnostic approaches to infectious anterior uveitis. Int Ophthalmol Clin. 2011;51(4):145–56.

    Article  PubMed  Google Scholar 

  6. Harper TW, Miller D, Schiffman JC, Davis JL. Polymerase chain reaction analysis of aqueous and vitreous specimens in the diagnosis of posterior segment infectious uveitis. Am J Ophthalmol. 2009;147(1):140–7, e2.

    Article  CAS  PubMed  Google Scholar 

  7. Farhadi A, Haniloo A, Fazaeli A, Moradian S, Farhadi M. PCR-based diagnosis of toxoplasma parasite in ocular infections having clinical indications of toxoplasmosis. Iran J Parasitol. 2017;12(1):56–62.

    PubMed  PubMed Central  Google Scholar 

  8. Montoya JG, Parmley S, Liesenfeld O, Jaffe GJ, Remington JS. Use of the polymerase chain reaction for diagnosis of ocular toxoplasmosis. Ophthalmology. 1999;106(8):1554–63.

    Article  CAS  PubMed  Google Scholar 

  9. de Boer JH, Verhagen C, Bruinenberg M, Rothova A, de Jong PT, Baarsma GS, et al. Serologic and polymerase chain reaction analysis of intraocular fluids in the diagnosis of infectious uveitis. Am J Ophthalmol. 1996;121(6):650–8.

    Article  PubMed  Google Scholar 

  10. Sjoholm-Gomez de Liano C, Soberon-Ventura VF, Salcedo-Villanueva G, Santos-Palacios A, Guerrero-Naranjo JL, Fromow-Guerra J, et al. Sensitivity, specificity and predictive values of anterior chamber tap in cases of bacterial endophthalmitis. Eye Vis (Lond). 2017;4:18.

    Article  Google Scholar 

  11. Van der Lelij A, Rothova A. Diagnostic anterior chamber paracentesis in uveitis: a safe procedure? Br J Ophthalmol. 1997;81(11):976–9.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cheung CM, Durrani OM, Murray PI. The safety of anterior chamber paracentesis in patients with uveitis. Br J Ophthalmol. 2004;88(4):582–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Augsburger JJ. Invasive diagnostic techniques for uveitis and simulating conditions. Trans Pa Acad Ophthalmol Otolaryngol. 1990;42:964–71.

    CAS  PubMed  Google Scholar 

  14. Manku H, McCluskey P. Diagnostic vitreous biopsy in patients with uveitis: a useful investigation? Clin Exp Ophthalmol. 2005;33(6):604–10.

    Article  PubMed  Google Scholar 

  15. Microbiologic factors and visual outcome in the endophthalmitis vitrectomy study. Am J Ophthalmol. 1996;122(6):830–46.

    Google Scholar 

  16. Lee EJ, Kim TW, Heo JW, Yu HG, Chung H. Natural killer/T-cell lymphoma of nasal type with intraocular involvement: case report. Eur J Ophthalmol. 2010;20(1):215–7.

    Article  PubMed  Google Scholar 

  17. Gonzales JA, Chan CC. Biopsy techniques and yields in diagnosing primary intraocular lymphoma. Int Ophthalmol. 2007;27(4):241–50.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Chan CC, Buggage RR, Nussenblatt RB. Intraocular lymphoma. Curr Opin Ophthalmol. 2002;13(6):411–8.

    Article  PubMed  Google Scholar 

  19. Michels RGGW, Engel HM, et al. Diagnostic vitrectomy. In: Jacobiec FASJ, editor. Techniques in ocular surgery. Philadelphia, PA: WB Saunders; 1984.

    Google Scholar 

  20. Turno-Krecicka A, Misiuk-Hojlo M, Grzybowski A, Oficjalska-Mlynczak J, Jakubowska-Kopacz M, Jurowska-Liput J. Early vitrectomy and diagnostic testing in severe infectious posterior uveitis and endophthalmitis. Med Sci Monit. 2010;16(6):Cr296–300.

    PubMed  Google Scholar 

  21. Bever GJ, Kim DJ, Afshar AR, Rubenstein JL, Damato BE. Therapeutic vitrectomy as an adjunct treatment to systemic chemotherapy for intraocular lymphoma. Retin Cases Brief Rep. 2017; https://doi.org/10.1097/ICB.0000000000000668. [Epub ahead of print].

  22. Sikic J, Suic SP. Surgical treatment of uveitis. Coll Antropol. 2001;25(Suppl):71–6.

    PubMed  Google Scholar 

  23. Kavanagh MC, Everman KR, Opremcak EM, Foster JA. Uveal melanoma with massive extrascleral extension via pars plana vitrectomy sites. Ophthal Plast Reconstr Surg. 2008;24(4):334–6.

    Article  PubMed  Google Scholar 

  24. Shen T, Liu R, Lin J, Huang H, Li X, Yan J. Pars plana vitrectomy and evisceration resulting in death due to misdiagnosis of retinoblastoma in children: a review of 3 cases. Medicine. 2015;94(32):e1338.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Whitcup SM, de Smet MD, Rubin BI, Palestine AG, Martin DF, Burnier M Jr, et al. Intraocular lymphoma. Clinical and histopathologic diagnosis. Ophthalmology. 1993;100(9):1399–406.

    Article  CAS  PubMed  Google Scholar 

  26. Davis JL, Viciana AL, Ruiz P. Diagnosis of intraocular lymphoma by flow cytometry. Am J Ophthalmol. 1997;124(3):362–72.

    Article  CAS  PubMed  Google Scholar 

  27. Davis JL, Miller DM, Ruiz P. Diagnostic testing of vitrectomy specimens. Am J Ophthalmol. 2005;140(5):822–9.

    Article  PubMed  Google Scholar 

  28. Blay JY, Burdin N, Rousset F, Lenoir G, Biron P, Philip T, et al. Serum interleukin-10 in non-Hodgkin’s lymphoma: a prognostic factor. Blood. 1993;82(7):2169–74.

    Article  CAS  PubMed  Google Scholar 

  29. Murray PI, Hoekzema R, van Haren MA, de Hon FD, Kijlstra A. Aqueous humor interleukin-6 levels in uveitis. Invest Ophthalmol Vis Sci. 1990;31(5):917–20.

    CAS  PubMed  Google Scholar 

  30. Wolf LA, Reed GF, Buggage RR, Nussenblatt RB, Chan CC. Vitreous cytokine levels. Ophthalmology. 2003;110(8):1671–2.

    Article  PubMed  Google Scholar 

  31. Cassoux N, Giron A, Bodaghi B, Tran TH, Baudet S, Davy F, et al. IL-10 measurement in aqueous humor for screening patients with suspicion of primary intraocular lymphoma. Invest Ophthalmol Vis Sci. 2007;48(7):3253–9.

    Article  PubMed  Google Scholar 

  32. Pulido JS, Salomao DR, Frederick LA, Viswanatha DS. MyD-88 L265P mutations are present in some cases of vitreoretinal lymphoma. Retina (Philadelphia, Pa). 2015;35(4):624–7.

    Article  CAS  Google Scholar 

  33. Treon SP, Hunter ZR, Castillo JJ, Merlini G. Waldenstrom macroglobulinemia. Hematol Oncol Clin North Am. 2014;28(5):945–70.

    Article  PubMed  Google Scholar 

  34. Yeh S, Weichel ED, Faia LJ, Albini TA, Wroblewski KK, Stetler-Stevenson M, et al. 25-gauge transconjunctival sutureless vitrectomy for the diagnosis of intraocular lymphoma. Br J Ophthalmol. 2010;94(5):633–8.

    Article  PubMed  Google Scholar 

  35. Chen RSDJ. Vitreoretinal surgery in inflamed eyes. Retin Physician. 2014;11:40–4.

    Google Scholar 

  36. Ranty ML, Laurent C, Aziza J, Mahieu L, Olle P, Quintyn JC, et al. Improving the cytological diagnosis of intraocular lymphoma from vitreous fluid. Histopathology. 2015;67(1):48–61.

    Article  PubMed  Google Scholar 

  37. Chan CC. Molecular pathology of primary intraocular lymphoma. Trans Am Ophthalmol Soc. 2003;101:275–92.

    PubMed  PubMed Central  Google Scholar 

  38. Peterson K, Gordon KB, Heinemann MH, DeAngelis LM. The clinical spectrum of ocular lymphoma. Cancer. 1993;72(3):843–9.

    Article  CAS  PubMed  Google Scholar 

  39. Whitcup SM, Chan CC, Buggage RR, Nussenblatt RB, Byrnes GA, Rubin BI. Improving the diagnostic yield of vitrectomy for intraocular lymphoma. Arch Ophthalmol. 2000;118(3):446.

    CAS  PubMed  Google Scholar 

  40. Malinowski SM. The vitreous trap: a simple, surgeon-controlled technique for obtaining undiluted vitreous and subretinal specimens during pars plana vitrectomy. Retina (Philadelphia, Pa). 2010;30(5):828–9.

    Article  Google Scholar 

  41. Haji MRF. Microincision vitrectomy surgery in infectious endophthalmitis. In: Patelli FRS, editor. Management of complicated vitreoretinal disease. New York, NY: Springer International; 2015. p. 131.

    Google Scholar 

  42. Quiroz-Mercado H, Rivera-Sempertegui J, Macky TA, Navarro-Lopez P, Griselda-Alvarez L, Ibarra-Ponce N, et al. Performing vitreous biopsy by perfluorocarbon-perfused vitrectomy. Am J Ophthalmol. 2005;140(6):1161–3.

    Article  PubMed  Google Scholar 

  43. Rutzen AR, Ortega-Larrocea G, Dugel PU, Chong LP, Lopez PF, Smith RE, et al. Clinicopathologic study of retinal and choroidal biopsies in intraocular inflammation. Am J Ophthalmol. 1995;119(5):597–611.

    Article  CAS  PubMed  Google Scholar 

  44. Johnston RL, Tufail A, Lightman S, Luthert PJ, Pavesio CE, Cooling RJ, et al. Retinal and choroidal biopsies are helpful in unclear uveitis of suspected infectious or malignant origin. Ophthalmology. 2004;111(3):522–8.

    Article  PubMed  Google Scholar 

  45. Chan CC, Palestine AG, Davis JL, de Smet MD, McLean IW, Burnier M, et al. Role of chorioretinal biopsy in inflammatory eye disease. Ophthalmology. 1991;98(8):1281–6.

    Article  CAS  PubMed  Google Scholar 

  46. Mastropasqua R, Thaung C, Pavesio C, Lightman S, Westcott M, Okhravi N, et al. The role of chorioretinal biopsy in the diagnosis of intraocular lymphoma. Am J Ophthalmol. 2015;160(6):1127–32, e1.

    Article  PubMed  Google Scholar 

  47. Martin DF, Chan CC, de Smet MD, Palestine AG, Davis JL, Whitcup SM, et al. The role of chorioretinal biopsy in the management of posterior uveitis. Ophthalmology. 1993;100(5):705–14.

    Article  CAS  PubMed  Google Scholar 

  48. Cole CJ, Kwan AS, Laidlaw DA, Aylward GW. A new technique of combined retinal and choroidal biopsy. Br J Ophthalmol. 2008;92(10):1357–60.

    Article  CAS  PubMed  Google Scholar 

  49. Browne AW, Ehlers JP, Sharma S, Srivastava SK. Intraoperative optical coherence tomography-assisted chorioretinal biopsy in the DISCOVER study. Retina (Philadelphia, Pa). 2017;37:2183–7.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Florida Retina Institute, Orlando, FL, USA

    Jaya B. Kumar

  2. Ophthalmology, Cole Eye Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Jaya B. Kumar & Sumit Sharma

Authors
  1. Jaya B. Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sumit Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Casey Eye Institute Oregon Health & Science University, Portland, OR, USA

    Phoebe Lin

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kumar, J.B., Sharma, S. (2020). Diagnostic Biopsy in Uveitis. In: Lin, P. (eds) Uveitis . Current Practices in Ophthalmology. Springer, Singapore. https://doi.org/10.1007/978-981-15-0331-3_8

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-0331-3_8

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-15-0330-6

  • Online ISBN: 978-981-15-0331-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation