Abstract
Purpose:
Vitreous biopsy may be an effective aid in determining the etiology of posterior segment inflammation. The yield of a conventional ''dry'' vitreous biopsy is approximately 1cc of undiluted vitreous, which is often insufficient for the battery of tests required. The use of perfluoron (PFO) infusion may provide a safe and efficient method of obtaining larger quantities of undiluted vitreous.
Methods:
We retrospectively reviewed diagnostic vitreous biopsies performed since 2005, before and after the adoption of the PFO technique in 2010 at Rush University Medical Center. Visual acuities, ocular comorbidities and additional intra-operative procedures and treatments were recorded. Biopsied eyes were divided into two groups based on surgical technique: PFO-assisted vitrectomy, and balanced saline solution (BSS)-infused vitrectomy. All analyses including cultures, polymerase chain reaction (PCR) testing, cytology, and flow cytometry that were performed on sufficient specimens were enumerated and reviewed for their aid in diagnosis. Statistical analysis was performed using a two-tailed t-test. Visual outcomes were also evaluated.
Results:
Twenty eyes of 19 patients having undergone vitreous biopsy were identified. Mean age at DOS was 56 (range 9-80). PFO was used in 9 eyes. An average of 6.33 diagnostic analyses were completed for each eye in the PFO-infused group, vs. 4.18 analyses for each BSS-infused biopsy (p = 0.55). Each group returned 3 analyses that were incomplete due to an insufficient amount of specimen. Definitive diagnoses were made in 2 eyes in the PFO group (both lymphoma) and 3 eyes in the BSS group (syphilis, cytomegalovirus, lymphoma); infection and/or malignancy were ruled out in the remaining cases in each group. Initial visual acuities in the PFO and BSS-infused groups averaged 20/125 and 20/400, respectively; at 3 months post-operatively, average acuities were 20/125 and 20/300, respectively. There were no intra-operative complications in either group.
Conclusions:
The availability of larger volumes of undiluted vitreous for testing may increase the diagnostic utility of vitreous biopsy. In this small study the increased number of completed tests in the PFO group does not reach statistical significance, but does support the clinical observation that use of PFO is a technique which may safely increase the amount of undiluted vitreous obtained.
Keywords: 763 vitreous •
467 clinical laboratory testing •
746 uveitis-clinical/animal model