Original article
Retinal Fluorescein, Indocyanine Green Angiography, and Optic Coherence Tomography in Non-Hodgkin Primary Intraocular Lymphoma

https://doi.org/10.1016/j.ajo.2008.12.025Get rights and content

Purpose

To determine the presence of clinicopathological correlations for primary intraocular non-Hodgkin lymphoma (NHL)in fluorescein angiographies (FA), indocyanine green (ICGA) angiographies, and optical coherence tomography (OCT) images.

Design

Comparative retrospective interventional case series.

Methods

Institutional practice. All serial patients who underwent vitreous sampling for cytological analysis over a 70-month period were reviewed. Clinical, angiographic, and tomographic findings present prior to tissue diagnosis were re-evaluated in a masked fashion.

Results

Cytological analysis of 256 vitreous specimens from 244 patients was performed. The final diagnoses were infections in 42 cases (17.2%) and immune-mediated diseases in 34 cases (13.9%). In 59 cases (24.2%), neoplastic disease was present, and 53 (21.7%) of these were primary intraocular NHL. OCT images showed nodular hyperreflective lesions in the retinal pigment epithelium (RPE) of both intraocular NHL and nonintraocular NHL patients. Clusters of numerous hypofluorescent small lesions revealed by FA that corresponded to punctate whitish lesions in the fundus and rare round clustered hypofluorescent lesions revealed by ICGA were associated with intraocular NHL diagnosis. The positive predictive value was 88.9% and the negative predictive value was 85%. The odds ratio risk was 45.22.

Conclusion

The presence of clusters of round stable hypofluorescent lesions in FA that are scarce in ICGA, with corresponding RPE hyperreflective nodular lesions on OCT, warrants obtaining biopsies for cytology, immunostaining, and molecular biology exams.

Section snippets

Patients and Methods

This is a comparative, retrospective, interventional case series. Each patient signed a consent form prior to surgery. We reviewed all patients who underwent vitreous sampling for cytological analyses over a 70-month period between January 1, 1999 and November 18, 2005.

Prior to tissue diagnosis, we assessed clinical characteristics, including best-corrected visual acuity and inflammation of the anterior segment that was objectively quantified by the Laser Cell Flare Meter (Kowa FC 1000, Tokyo,

Results

Over the 70-month period, cytological analysis was performed on 256 specimens of vitreous from 244 patients. Twelve patients had 2 vitreous samplings. Women constituted 56% of the patients, and the mean age was 56.3 ± 17.6 years old.

We performed 17 vitrectomies in patients with acute infections including 7 patients with acute endophthalmitis and10 with systemic candida. There were 14 patients with chronic infections, and vitrectomies showed 7 with Toxoplasma gondii, 4 with Toxocara, 2 with

Discussion

A previous study reported that FA in intraocular NHL showed the presence of disturbances in the RPE.3 These disturbances were described as blockages and late staining. In our current work, the clusters of small hypofluorescent lesions were well-defined in the early phase and remained hypofluorescent in the late phase, indicating a masking effect of the choroidal fluorescence. This pattern was present in 45% of the intraocular NHL cases, compared with 2% of the nonintraocular NHL cases. The

Dr Christine Fardeau, has acquired the specialization in Ophthalmology in 1991 and has been a fellow from 1990 to 1993. She has obtained a diploma of Applied Statistics from Medicine Paris XI and a masters of Cell Biology. Dr Fardeau is formerly a Hospital physician and Chief Consultant from 1994 at the Department of Ophthalmology lead by Prof P. LeHoang in Pitié-Salpétrière Hospital, where she currently has managed medical and surgical treatment in uveitis patients. Dr Fardeau has written

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    Dr Christine Fardeau, has acquired the specialization in Ophthalmology in 1991 and has been a fellow from 1990 to 1993. She has obtained a diploma of Applied Statistics from Medicine Paris XI and a masters of Cell Biology. Dr Fardeau is formerly a Hospital physician and Chief Consultant from 1994 at the Department of Ophthalmology lead by Prof P. LeHoang in Pitié-Salpétrière Hospital, where she currently has managed medical and surgical treatment in uveitis patients. Dr Fardeau has written several publications and belongs to several scientific associations such as the Association for Research in Vision and Ophthalmology and the International Uveitis Study Group. Dr Fardeau paraprofessional experiences have included voluntary ophthalmological service in various associations in Columbia and in France.

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