Diagnostic Vitreous Biopsy Under Air

In this 1-Minute Video, Drs. Rishi Gupta and Darrell Lewis perform diagnostic vitreous biopsy under air. The patient was referred with bilateral vitritis and optic disc edema. Fluorescein angiography revealed leakage at the nerve and along the retinal vessels, and OCT showed edema extending from the nerve into the macula. The patient consented for a diagnostic vitrectomy. Valve trocars were placed and the biopsy was performed under air infusion, allowing for 4 mL of undiluted vitreous to be obtained while avoiding significant hypotony. Since the surgeons were suspicious of primary vitreal retinal lymphoma, they used a low cut rate of 600 cuts per minute to reduce damage to the sample. The sample was sent for cytology, flow cytometry, MYD88 PCR and IL-10/IL-6 levels. Results confirmed diffused large B-cell lymphoma and treatment was initiated with intravitreal methotrexate injections as per the protocol from Fishburne, et al.

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