The Usefulness of Diagnostic Vitrectomy in Neoplastic and Non-Neoplastic Masquerade Syndrome: An Observational Study

Research Article

Ann Hematol Oncol. 2021; 8(10): 1369.

The Usefulness of Diagnostic Vitrectomy in Neoplastic and Non-Neoplastic Masquerade Syndrome: An Observational Study

Morawski K*

Ophthalmology Unit, St. Rose Hospital, Kraków, Poland

*Corresponding author: Krzysztof Morawski, Ophthalmology Unit, St. Rose Hospital, Kraków, Skotnicka 230A Poland

Received: June 23, 2021; Accepted: July 16, 2021; Published: July 23, 2021


Introduction: Masquerade intraocular inflammation may be considered neoplastic or non- neoplastic masquerades such as primary intraocular lymphoma, leukemia, infectious and inflammatory diseases. These pathologies require a definitive diagnosis, as the treatment modalities are different. The aim of our study was to investigate the safety and usefulness of diagnostic vitrectomy with vitreous humor flow cytometry in eyes with intraocular inflammation of unknown etiology.

Methods: A retrospective observational study included 35 eyes of 29 patients with atypical intraocular inflammation unresponsive to corticosteroid therapy. In all cases diagnostic vitrectomy with flow cytometry analysis of the vitreous specimen was performed.

Results: Among 35 eyes, the result of diagnostic vitrectomy analysis showed unspecific inflammatory response in 7 (20.0%) eyes, confirmed neoplastic diseases in 5 (14.3%) eyes. All of them it was intraocular lymphoma but one of the eyes with primarily diagnosed lymphoma and one of the eyes with primarily diagnosed unspecific inflammatory response in flow cytometry has been diagnosed finally as a choroidal melanoma after enucleation of the eyeball. Diagnostic vitrectomy excluded neoplastic disease in 7 eyes (20.0%). In 3 eyes (8.6%) bacterial infection, in 4 eyes (11.4%) viral infection. In 2 eyes (5.7%) we excluded bacterial infection, in 7 cases (20.0%) no conclusive results were obtained. The most common adverse event was cataract in patients (12 eyes, 34.3%).

Conclusion: Diagnostic vitrectomy with flow cytometry of vitreous humor is helpful in confirming the clinical suspected diagnosis of posterior segment inflammation. Flow cytometry need to be complemented with other diagnostic test including cytopathology, especially in cases suspected of intraocular lymphoma. Flow cytometry of the vitreous humor in choroidal melanoma is not a useful diagnostic tool.

Keywords: Diagnostic vitrectomy; Flow cytometry; Intraocular inflammation; Intraocular lymphoma


Intraocular inflammation of the posterior segment of the eye may be associated with ocular masquerade syndrome due to neoplastic, infectious and inflammatory diseases [1-3]. In most cases, the clinical features are so characteristic that performing standard other diagnostic tests allows confirming the diagnosis and implementing of appropriate treatment.

In cases where the clinical picture is not characteristic and cannot be diagnosed, and when therapy with steroids is not effective, performing diagnostic vitrectomy with the use of flow cytometry may be an additional diagnostic tool [4]. This is particularly important in conditions that potentially are sight threatening or even mortal such as vitreoretinal or choroidal lymphoma [5]. In those cases, a valuable result is also the exclusion of the presence of lymphoma cells in the vitreous specimen tested. In addition, biopsy of retinal and choroidal lesions can be obtained during diagnostic vitrectomy after vitreous sampling [8]. The aim of our study was to assess the safety of diagnostic vitrectomy and the effectiveness of confirming clinical diagnosis in cases of atypical or not responding to empiric treatment intraocular inflammation and lesions suspected of being a neoplastic process.

Materials and Methods

We performed an observational, retrospective study of 35 eyes of 29 patient who underwent 23G diagnostic vitrectomy at the another unit between the years 2013-2019. The patients were divided into the following groups according to the suspected diagnosis: idiopathic posterior uveitis unresponsive to corticosteroid treatment 15 eyes (42.9%), suspected neoplastic disease 15 eyes (42.9%), viral retinitis 2 eyes (5.7%) and patient with other intraocular lesion with haemophtalmus or endogenous endophthalmitis 3 eyes (8.6%) (Table 1). Patients included in the study underwent serum testing for all known causes of posterior uveitis (tuberculosis, syphilis, HIV, HSV, CMV, VZV, Toxoplasma gondii) which did not allow to establish a definitive diagnosis [2,4,5]. Two-three weeks before vitrectomy the steroids were stopped. Patients were evaluated preoperatively, on postoperative day one, after six weeks and six month follow up. Preoperative clinical data was collected from each patient including age and sex. Ophthalmic data included findings obtained on clinical examination, which included Best Corrected Visual Acuity (BCVA) assessed with Snellen charts, Intraocular Pressure (IOP), anterior and posterior segment assessment, ultrasonography A- and B-scan and in selected cases Fluorescein Angiography (FA). The follow-up examinations were performed one day postoperatively, then 1 week, 1 month and 6 month after surgery and then the follow-ups depended on the clinical status of the patient and included the same parameters as the baseline tests except for FA. In all cases, vitreous specimens underwent the following testing: microbiological culture, PCR test for viruses (HSV-DNA, CMV-DNA, VZV-DNA) and Toxoplasma gondii and cytofluorometric analysis with flow cytometry. The vitreous specimens for analysis were sent to laboratory immediately after taken. In patients with positive serum tests for tuberculosis (QuantiFeron Tbc Gold test), a vitreous examination was performed for the presence of tuberculosis mycobacteria DNA using a genetic probe (Becton Dickinson). The results of diagnostic vitrectomy were divided into the following groups: unspecific inflammatory response, confirmed neoplastic disease, viral infection, bacterial infection, excluded neoplastic disease, excluded bacterial infection and no conclusive results (Table 1).