OCT 23, 2012
This retrospective study evaluated the clinical features of 217 patients with intraocular lymphoma and the diagnostic significance of analyzing vitreous samples. The authors found that cytokine analysis of vitreous biopsy had the highest detection rate for intraocular lymphoma and concluded that this supplementary test should be performed frequently to confirm this diagnosis.
The patients were seen at 25 medical institutions in Japan. They were observed for a mean of 41.3 months, during which 69 patients had onset of lymphoma in one eye and 148 had onset in both eyes. The five-year survival rate was 61.1 percent.
Intraocular lymphoma with involvement of the central nervous system was most common, found in 60.8 percent of patients, while intraocular lymphoma without involvement of other organs occurred in 28.1 percent. Eight-three percent developed primary ocular lesions, whereas 16.1 percent developed primary central nervous system lesions preceding intraocular lymphoma.
Blurred vision and ataxia were the most common ocular and extra-ocular symptoms that prompted patients to seek medical examination. Vitreous opacification was the most common ocular finding.
Malignant cytology was detected in 44.5 percent of patients tested, IL-10/IL-6 ratio greater than 1.0 in 91.7 percent, and IgH gene rearrangements in vitreous specimens in 80.6 percent. However, among the 52 patients examined by all three tests (cytological examination, cytokine analysis and molecular analysis), only 10 cases (19.2 percent) tested positive for all three.
The authors found that positive rates of cytological analysis and IgH gene rearrangements were different in patients with vitreous opacification and those without, whereas the positive rate for IL-10/IL-6 ratio greater than 1.0 was constantly high (at least 90 percent) irrespective of the presence of vitreous opacification.