Diagnosis of intraocular lesions using vitreous humor and intraocular perfusion fluid cytology: Experience with 83 Cases

Abstract

An early diagnosis and treatment of intraocular diseases is necessary to maintain an acceptable degree of quality of life. For an accurate diagnosis, it is necessary to understand the anatomy of the eye. Giemsa staining is recommended in addition to Papanicolaou staining for cytologic diagnostic evaluation of intraocular diseases. Furthermore, for the diagnosis of clonality in intraocular lymphomas, it is often necessary to use ancillary molecular biological procedures, using vitreous fluid.

Cytopathology of Vitreous Humor Samples in Routine Practice

“…Asteroid bodies were found in 4 cases. This finding is specific to asteroid hyalosis, which is an infrequent degenerative disease of unknown etiology [13,16]. In our study, as in previous studies, neutrophils and/or eosinophils were observed in all mycotic, parasitic or bacterial infections [3,12,14].…”

“…Of these cell types, epithelial cells were the most frequently observed. Some cells of the retina have been previously observed in vitreous fluid, such as Müller's cells, pigmented epithelial cells, rod cells and ganglion cells [13]. It has been reported that retinal cells can appear as round cells and be misinterpreted as malignant cells in some cases when stained by the PAP method [13].…”

“…The use of special stains such as periodic acid Schiff, Grocott-Gomori or calcofluor white can improve the detection of the mycelia filament [26]. However, nonmycotic infectious agents, such as T. canis , T. gondii and P. acnes , have never been found upon cytological examination [13,15]. Therefore, when an infection is suspected, a fresh sample of vitreous fluid (diluted with infusion fluid or not) should be divided and dispatched to both the pathology and microbiology laboratories.…”

“…Moreover, the vast majority of cytological studies have focused on the distinction between chronic uveitis and primary intraocular lymphoma [4,5,6,8,9,10,11,19]. Only a few studies have described nonneoplastic cytology and routine cytology of vitreous samples [3,12,13,14,15,16]. …”

“…Vitrectomy can also be used as a diagnostic tool in cases of clinically undiagnosed uveitis or uveitis with an atypical clinical course, suspected infectious endophthalmitis or suspicion of intraocular malignancy [3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. In these cases, cytological analysis combined with appropriate ancillary testing, such as microbiological analysis, flow cytometry and interleukin (IL) measurement, is a valuable tool that can lead to a final clinical diagnosis in most cases [8].…”