September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Determination of CD4/CD8 ratio in undiluted vitreous samples provides useful information for the diagnosis of ocular sarcoidosis
Author Affiliations & Notes
  • Joachim Van Calster
    University Hospitals Leuven, Leuven, Belgium
  • Rita Van Ginderdeuren
    University Hospitals Leuven, Leuven, Belgium
  • Footnotes
    Commercial Relationships   Joachim Van Calster, None; Rita Van Ginderdeuren, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 3315. doi:
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      Joachim Van Calster, Rita Van Ginderdeuren; Determination of CD4/CD8 ratio in undiluted vitreous samples provides useful information for the diagnosis of ocular sarcoidosis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3315.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose : The diagnosis of ocular sarcoidosis is not always straightforward. Patients with ocular sarcoidosis present with a wide range of clinical symptoms and severity. In patients with a suspicious intraocular presentation, screening for pulmonary disease is mandatory and other causes of uveitis have to be ruled out. Often, the systemic workup turns out to be inconclusive. In these cases intraocular invasive techniques can be of added value. In this study, we examined the usefulness of CD4/CD8 ratio in vitreous fluid in diagnosing ocular sarcoidosis.

Methods : 137 eyes of 137 consecutive patients with unsolved intermediate or posterior uveitis were studied. A 1.5-2.5cc undiluted vitreous sample was isolated through a single 23G or 27G port using the EVA vitrectomy platform (DORC) with a twin duty cycle high speed cutter. The samples were analyzed with the Cellient® tissue processor (Hologic). Routine histochemical and immunostainings were evaluated. In patients with active chronic inflammation (= presence of CD68+ macrophages and >5% CD3+ lymphocytes), further evaluation of granulomatous disease was performed and CD4/CD8 ratio was assessed. An elevated CD4/CD8 ratio was defined as higher than 3. The post-operative complications were evaluated.

Results : In 94.9% of the cases, sufficient material was found to provide an added value in the diagnostic workup. In 42.3% the diagnosis was a chronic active inflammation. In this group 39.6% revealed a granulomatous inflammatory process, defined by the presence of clustered CD68+ cells or multinucleated giant cells. 69.6% of the patients with granulomatous inflammation had an elevated CD4/CD8 ratio. All patients with known pulmonary sarcoidosis had an elevated CD4/CD8 ratio. There were no post-operative retinal tears, infections or retinal detachments noticed.

Conclusions : The standardized protocol used at our center for sampling and handling undiluted vitreous biopsies is a safe procedure. In patients with histopathological evidence of granulomatous disease into the vitreous, 69.6% had an increased CD4/CD8 ratio. Moreover, this ratio was increased to 100% in the category known pulmonary sarcoidosis patients in this series. Hence, determination of this ratio is of added value in the diagnosis of (ocular) sarcoidosis.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.


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