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surya Prakash sharma, Aman Kumar, Vishali Gupta, ANIRUDDHA AGARWAL, Nalini Gupta, Reema bansal, Raman deep Singh, Mohit dogra, Nirbhai Singh, Deeksha Katoch, Shobha Sehgal; Intraocular lymphoma: Biomarkers revisited.. Invest. Ophthalmol. Vis. Sci. 2020;61(7):35.
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© ARVO (1962-2015); The Authors (2016-present)
Intraocular lymphoma (IOL) poses a serious diagnostic challenge as a masquerade syndrome mimicking uveitis of varied etiologies. Identifying malignant cells in the vitreous remains the gold standard for diagnosis but may be inconclusive in many cases. Thus, there is an unmet need to have rapid, reliable biological markers to establish an early diagnosis of IOL.
A total of 77uveitis patients undergoing diagnostic pars plana vitrectomy were enrolled between October 2017 to April 2019. Diagnostic vitrectomy specimens were subjected to cytological examination. In addition, using flowcytometric analysis, we calculated the IL6 and IL10 assay, and T and B lymphocyte population and monoclonality. Gene mutation for MyD88-L265P was performed.
Thirteen out of 77 patients were confirmed to have IOL. Initial cytology was indeterminate in 4/13 patients. However, the flow cytometric analysis revealed mainly B cell population with kappa or lambda light chain monoclonality. In 12/13 eyes using flow cytometry, raised levels of IL10, and IL10/IL6 ratio of >1 was observed. An IL10/IL6 ratio of ≥1 from the vitreous fluid had a sensitivity of 92.86% and a specificity of 94.74% for the diagnosis of IOL. Assessment of cytology slides prepared within one hour of PPV confirmed the diagnosis of IOL, reaffirming the significance of cold chain.
Predominant presence of B-cells with skewed distribution of kappa and lambda light chains along with IL10/IL6 ratio ≥1can be a powerful tool to clinch the diagnosis of IOL. Further, MyD88 mutation, if present, can strengthen the diagnosis.
This is a 2020 ARVO Annual Meeting abstract.
Figure 1a: Fundus photograph shows diffuse vitritis with sub-retinal yellowish deposits. Red free image shows the sub-retinal deposits. OCT shows a diffuse sheet of sub-retinal deposit material corresponding to yellowish lesions on fundus as representative by yellow circle.
Figure 1b: Depicts IL6/IL10 ratios in 8 representative cases of lymphoma consistently showing markedly raised IL10/IL6 ratios.
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