Surgical approach to subretinal washout biopsy for primary vitreoretinal lymphoma (PVRL).

Abstract

Introduction: We describe a case of primary vitreoretinal lymphoma (PVRL) masquerading as vitritis with subretinal lesions. We employed a subretinal washout and aspiration approach in addition to the standard vitreous biopsy.

Methods: An anterior chamber tap followed by a dry vitreous biopsy were performed. Infusion was then switched on and a complete 25G right pars plana vitrectomy was then completed. To obtain further sampling material, balanced salt solution (BSS) was injected subretinally with a 41G extendible needle which was then aspirated and sent for cytohistopathological analysis. Subsequently, a fluid-air exchange was performed for tamponade. No laser retinopexy was performed.

Results: Our patient had a positive vitreous and sub-retinal washout cytology with a mixed population of cells with smaller enlarged lymphocyte-like cells. A further polymerase chain-reaction (PCR) showed a clonal IGK gene rearrangement, indicating a clonal B-cell population. Further sample testing was positive for the MyD88 L265P gene mutation. No intracranial or leptomeningeal involvement was present on MRI head. At three months, her vision improved to 6/7.5 (20/25 or 0.1 LogMAR) with a pinhole in both eyes.

Conclusion: Primary vitreoretinal lymphoma is an aggressive malignancy with a high mortality rate. A prompt diagnosis and treatment are essential. In the presence of subretinal lesions, subretinal fluid aspiration may increase the sensitivity in diagnosing PVRL. Additionally, it may aid visual acuity recovery long-term.