SURGICAL APPROACH TO SUBRETINAL WASHOUT BIOPSY FOR PRIMARY VITREORETINAL LYMPHOMA

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

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

Our patient had a positive vitreous and subretinal washout cytology with a mixed population of cells with smaller enlarged lymphocyte-like cells. A further polymerase chain reaction 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 3 months, her vision improved to 6/7.5 (20/25 or 0.1 LogMAR) with a pinhole in both eyes.

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. In addition, it may aid visual acuity recovery long term.