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W. O. Siu, R. Shah, L. Faia, C. C. Chan, R. B. Nussenblatt, H. N. Sen; An Evaluation of the Diagnostic Work-Up for Primary Intraocular Lymphoma. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5738.
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To evaluate the diagnostic approach in patients with primary intraocular lymphoma.
A retrospective medical record review of PIOL patients referred to the NEI from 1998 to 2008 was performed. Time from the onset of first ocular symptoms to definitive diagnosis was evaluated with respect to diagnostic procedures performed. Procedures considered to be potentially diagnostic and if positive, would lead to initiation of treatment were: lumbar puncture (LP), pars plana vitrectomy (PPV), vitreous tap, anterior chamber aspiration, chorioretinal biopsy, and brain biopsy.
A review of 20 medical records of PIOL patients revealed that the average number of diagnostic procedures required for a definitive diagnosis was 3.3. The time between the onset of first ocular symptoms suspicious for PIOL and the definitive diagnosis was 27.3 months (range 3-96 months). The most commonly ordered diagnostic test was PPV (45%), followed by LP (30%). Laboratory evaluation of vitreous specimens obtained from PPV most commonly led to the definitive diagnosis (70% of cases) based on cytology. In cases where LP was evaluated prior to or in concert with PPV, cerebral spinal fluid (CSF) was positive for lymphoma cells in 40% of cases based on cytology and/or flow cytometry.
The diagnostic work-up of PIOL continues to be a challenge both as an initial differential consideration and even once highly suspected clinically. The duration of time to definitive diagnosis from the onset of first ocular symptoms, in addition to the number of procedures required, demonstrate the need for persistence so that treatment can be initiated for this life threatening disease. Additionally, a relatively high success rate for CSF evaluation in making a definitive diagnosis, when analyzed using both cytology and flow cytometry, should emphasize its use as a rapid and less invasive procedure that should be recommended both as an initial screening method and for more frequent follow-up when initial exams were negative, especially in cases where PIOL is highly suspected in the differential.
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