Objective: To describe findings in vitreous fluid samples in routine cytology practice. Study Design: The pathology archives from 1988 to 2008 at our institution were searched for vitreous samples. The slides were reviewed and clinical and follow-up information was obtained. Results: One hundred and eighty-two vitreous fluid samples from 166 patients were analyzed. Most of the samples had been collected for vitreous hemorrhage (75 cases). The second reason for vitreous sample cytological evaluation was an intraocular inflammatory process (55 cases). A specific cause of inflammation was found by combining clinical, microbiological and cytopathological findings in 19 cases, i.e. infection in 7, sarcoidosis in 3, retinal necrosis in 3, lens-induced endophthalmitis in 2, uveitis associated with systemic disease in 2, retrobulbar neuritis in 1 and sympathetic ophthalmia in 1. Among the 19 samples from 16 patients collected to rule out malignancy, 8 had a confirmed intraocular malignancy. Malignant cells were observed in 5 cases (3 lymphomas, 1 melanoma and 1 carcinoma). Undiagnosed malignancies included 2 lymphomas and 1 choroidal melanoma. Other samples were collected during surgery for retinal detachment and cataracts. Conclusions: In routine practice, cytology of the vitreous fluid is performed in many and varied situations that are most often nonneoplastic. In nonneoplastic cases, cytology is a useful adjunct to vitrectomy, in spite of its limitations.

Keywords:
Uveitis, Vitrectomy, Neoplasia, Ophthalmic pathology, Vitreous humor
1.
Sebag J: The Vitreous - Structure, Function and Pathobiology. New York, Springer 1989.
2.
Kuhn F, Aylward B: Rhegmatogenous retinal detachment: a reappraisal of its pathophysiology and treatment. Ophthalmic Res 2014;51:15-31.
3.
Zhai J, Harbour JW, Smith ME, Davila RM: Correlation study of benign cytomorphology and final clinical diagnosis. Acta Cytol 2008;52:196-200.
4.
Mruthyunjaya P, Jumper JM, McCallum R, Patel DJ, Cox TA, Jaffe GJ: Diagnostic yield of vitrectomy in eyes with suspected posterior segment infection or malignancy. Ophthalmology 2002;109:1123-1129.
5.
Svozilkova P, Heissigerova J, Brichova M, Kalvodova B, Dvorak J, Rihova E: The role of pars plana vitrectomy in the diagnosis and treatment of uveitis. Eur J Ophthalmol 2011;21:89-97.
6.
Wittenberg LA, Maberley DA, Ma PE, Wade NK, Gill H, White VA: Contribution of vitreous cytology to final clinical diagnosis fifteen-year review of vitreous cytology specimens from one institution. Ophthalmology 2008;115:1944-1950.
7.
Palexas GN, Green WR, Goldberg MF, Ding Y: Diagnostic pars plana vitrectomy report of a 21-year retrospective study. Trans Am Ophthalmol Soc 1995;93:281-308.
8.
Margolis R, Brasil OF, Lowder CY, Singh RP, Kaiser PK, Smith SD, et al: Vitrectomy for the diagnosis and management of uveitis of unknown cause. Ophthalmology 2007;114:1893-1897.
9.
Davis JL, Miller DM, Ruiz P: Diagnostic testing of vitrectomy specimens. Am J Ophtalmol 2005;140:822-829.
10.
Kinoshita Y, Takasu K, Adashi Y, Yuri T, Nagumo S, Shikata N: Retrospective cytological study of intraocular lymphoma using vitreous and intraocular perfusion fluid. Diagn Cytopathol 2012;40:604-607.
11.
Manku H, McCluskey P: Diagnostic vitreous biopsy in patients with uveitis: a useful investigation? Clin Experiment Ophthalmol 2005;33:604-610.
12.
Liu K, Klintworth GK, Dodd LG: Cytologic findings in vitreous fluids: analysis of 74 specimens. Acta Cytol 1999;43:201-206.
13.
Kinoshita Y, Takasu K, Kobayashi TK, Yuri T, Tsubura A, Shikata N: Diagnosis of intraocular lesions using vitreous humor and intraocular perfusion fluid cytology: experience with 83 cases. Diagn Cytopathol 2015;43:353-359.
14.
Caya JG, Clowry LJ, Wollenberg NJ, Aaberg TM, Tieu TM: The clinicopathologic significance of vitreous fluid cytology examinations in a series of 38 patients. Diagn Cytopathol 1985;1:267-271.
15.
Fischler DF, Prayson RA: Cytologic specimens from the eye: a clinicopathologic study of 33 patients. Diagn Cytopathol 1997;17:262-266.
16.
Mehta M, Rasheed RA, Duker J, Reichel E, Feinberg E, Husain D, et al: Vitreous evaluation: a diagnostic challenge. Ophthalmology 2015;122:531-537.
17.
Hwang CS, Yeh S, Bergstrom CS: Diagnostic vitrectomy for primary intraocular lymphoma: when, why, how? Int Ophthalmol Clin 2014;54:155-171.
18.
Jeroudi A, Yeh S: Diagnostic vitrectomy for infectious uveitis. Int Ophthalmol Clin 2014;54:173-197.
19.
Garweg JG, Wanner D, Sarra GM, Altwegg M, Loosli H, Kodjikian L, et al: The diagnostic yield of vitrectomy specimen analysis in chronic idiopathic endogenous uveitis. Eur J Ophthalmol 2006;16:588-594.
20.
Ranty ML, Laurent C, Aziza J, Mahieu L, Olle P, Quintyn JC, et al: Improving the cytological diagnosis of intraocular lymphoma from vitreous fluid. Histopathology 2015;67:48-61.
21.
Joshi M, Agrawal S, Christoforidis JB: Inflammatory mechanisms of idiopathic epiretinal membrane formation. Mediators Inflamm 2013;2013:192582.
22.
Hiscott PS, Grierson I, McLeod D: Natural history of fibrocellular epiretinal membranes: a quantitative, autoradiographic, and immunohistochemical study. Br J Ophthalmol 1985;69:810-823.
23.
Sakamoto T, Ishibashi T: Hyalocytes: essential cells of the vitreous cavity in vitreoretinal pathophysiology? Retina 2011;31:222-228.
24.
Zhao F, Gandorfer A, Haritoglou C, Scheler R, Schaumberger MM, Kampik A, et al: Epiretinal cell proliferation in macular pucker and vitreomacular traction syndrome: analysis of flat-mounted internal limiting membrane specimens. Retina 2013;33:77-88.
25.
Schumann RG, Gandorfer A, Ziada J, Scheler R, Schaumberger MM, Wolf A, et al: Hyalocytes in idiopathic epiretinal membranes: a correlative light and electron microscopic study. Graefes Arch Clin Exp Ophthalmol 2014;252:1887-1894.
26.
Kumar RS, Ganvir S, Hazarey V: Candida and calcofluor white: study in precancer and cancer. J Oral Maxillofac Pathol 2009;13:2-8.
27.
Kinoshita Y, Takasu K, Adachi Y, Yuri T, Matsunaga S, Nagumo S, Shikata N: Diagnostic utility of vitreous humor fluid cytology for intraocular sarcoidosis: a clinicopathologic study of 7 cases. Diagn Cytopathol 2012;40:210-213.
28.
Matsuo T, Ichimura K: Immunocytochemical diagnosis as inflammation by vitrectomy cell blocks in patients with vitreous opacity. Ophthalmology 2012;119:827-837.
29.
Dávila RM, Miranda MC, Smith ME: Role of cytopathology in the diagnosis of ocular malignancies. Acta Cytol 1998;42:362-366.
30.
Perske C, Nagel I, Nagel H, Strik H: CSF cytology - the ongoing dilemma to distinguish neoplastic and inflammatory lymphocytes. Diagn Cytopathol 2011;39:621-626.
31.
Ylagan LR: Intraocular pigmented proliferations in the context of cytologic evaluation. Diagn Cytopathol 2009;37:853-864.
32.
Laver NV, Rubinfeld RS, Baum M, de Brito PA: Cytomorphology of a mixed pigmented/nonpigmented pleomorphic adenoma of the ciliary body: a diagnostic pitfall in the evaluation of intraocular tumors. Diagn Cytopathol 1996;14:259-262.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.