Epibulbar Seeding of Uveal MALT Lymphoma Following Vitrectomy

Purpose: One of the most feared complications of intraocular tumor biopsy with fine needle aspiration biopsy (FNAB) or vitrectomy-assisted biopsy is seeding of the tumor cells directly into the needle tract. We present a case of epibulbar seeding of uveal MALT lymphoma following vitrectomy. Observations: A 67-year-old male presented with painless loss of vision of the left eye and creamy yellow infiltrates at the level of the choroid. A diagnostic 25-gauge pars plana vitrectomy was performed using a standard 3-port approach. Choroidal biopsy of the lesion demonstrated the presence of Mucosa-Associated Lymphoid Tissue (MALT) lymphoma. Three weeks following vitrectomy, the patient developed a large fleshy subconjunctival mass centered over the prior superonasal sclerotomy site. The lesion was completely excised and histopathology of the lesion demonstrated MALT lymphoma with an identical immunohistochemical staining pattern to that of the choroidal lesion. Conclusions and Importance: Transvitreal biopsy with fine needle aspiration or vitrectomy is an increasingly common and safe procedure for clinical diagnosis of intraocular tumors. However, there is a risk of tumor seeding of the needle tract and precautions to reduce this risk are warranted.