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A. W. Scott, P. Mruthyunjaya, G. J. Jaffe; Diagnostic Yield of Vitreous Biopsy in Sarcoid Uveitis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5158.
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Diagnostic vitrectomy is frequently used to help establish a diagnosis in challenging uveitis cases. The usefulness of this procedure in patients with suspected sarcoidosis, in whom a diagnosis cannot be determined by conventional methods has not been well described. We hypothesized that diagnostic vitrectomy would help establish the diagnosis in these challenging cases. Herein, we evaluated the diagnostic yield of vitreous biopsy in patients with suspected sarcoidosis-associated uveitis that affected the posterior segment.
Cases of intermediate, posterior, or panuveitis that could not be characterized by clinical examination, ancillary, and laboratory tests were considered for diagnostic pars plana vitrectomy. Retrospective chart review was conducted on consecutive eyes that underwent diagnostic, or diagnostic and therapeutic vitrectomy by a single surgeon from January 1989 to June 2006.
Diagnostic and therapeutic vitrectomy was performed on 142 eyes. Eight of these vitreous specimens (5.6%) yielded cytopathology consistent with sarcoidosis. Non-caseating granulomas were observed in 5/8 (62.5%). Multinucleated giant cells without specific mention of granuloma formation were found in 3/8 (37.5%). The results of vitreous biopsy helped guide therapy in all cases.
Lung, lacrimal gland, and conjunctiva are among the tissues commonly biopsied to confirm the diagnosis of sarcoidosis. The utility of vitreous biopsy in diagnosing sarcoidosis has not been previously described. This study demonstrates that 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 confirm the diagnosis of sarcoidosis and help tailor therapy.
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