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LETTER TO EDITOR
Year : 2006  |  Volume : 54  |  Issue : 1  |  Page : 64-65

Bilateral vitreous hemorrhage in an elderly male


Retina - Vitreous Service, Aravind Eye hospital and Postgraduate Institute of Ophthalmology, 1,Anna Nagar, Madurai - 625 020, India

Correspondence Address:
Vasumathy Vedantham
Retina - Vitreous Service, Aravind Eye hospital and Postgraduate Institute of Ophthalmology, 1,Anna Nagar, Madurai - 625 020
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.21624

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How to cite this article:
Vedantham V, Balasubramaniam KR. Bilateral vitreous hemorrhage in an elderly male. Indian J Ophthalmol 2006;54:64-5

How to cite this URL:
Vedantham V, Balasubramaniam KR. Bilateral vitreous hemorrhage in an elderly male. Indian J Ophthalmol [serial online] 2006 [cited 2020 Jun 3];54:64-5. Available from: http://www.ijo.in/text.asp?2006/54/1/64/21624

Dear Editor,

Intraocular masquerade syndromes such as retinovitreal form of reticulum cell sarcoma (large-cell B-lymphocytic malignant lymphoma), amyloidosis etc., usually present with characteristic bilateral opacities in the vitreous, simulating uveitis with especially sheet like membranes seen in the latter condition.[1] We recently encountered a case of leathery vitreous membranes due to long standing vitreous hemorrhage secondary to vasculitis.

A 60-year-old male presented to us with defective vision in both the eyes of nearly simultaneous onset of one year duration. He had no known systemic illness. Past and family histories were noncontributory. There was no history of head trauma. Ocular examination revealed a best corrected visual acuity of 20/200 in both the eyes. Anterior segment examination was normal in both the eyes. Posterior segment examination revealed dense leathery vitreous membranes of yellowish white color obscuring the fundus view in both the eyes. [Figure - 1]A,B. B-scan ultrasonography showed the presence of dense freely mobile vitreous membranes, with a complete posterior vitreous detachment (PVD) and attached retina in both the eyes. Systemic examination including complete hemogram, erythrocyte sedimentation rate, chest X-ray, CT scan of the central nervous system (to rule out a co-existent CNS lymphoma), and Mantoux were non-contributory. Due to the morphological appearance of the vitreous membranes, bilaterality and old age of the patient, a provisional diagnosis of intraocular lymphoma or amyloidosis was made. However, there were no signs of systemic or ocular amyloidosis.

The patient was scheduled for a diagnostic and therapeutic vitrectomy initially in the right eye. A 3 port pars plana vitrectomy was done. An undiluted vitreous sample of 0.3 ml was collected in l ml syringe and sent for cytological and microbiological analysis. Intra operatively complete PVD was encountered and the membranes were cleared completely. There were no whitish infiltrations in the retina which has been noted previously in adult T-cell leukemia presenting as vitreous membranes.[2] Patches of focal vasculitis was seen throughout the fundus [Figure - 1]C.After completion of vitrectomy, the patient underwent endo laser and fluid -air exchange. The vitreous sample was analyzed as described previously with certain modifications.[3] Briefly, the sample was ultracentrifuged (Thermoshandon, Cytospine 3) at 300 rpm for 3 minutes. The sediment from the centrifuge was embedded in hot paraffin tissue block and 18-20 microsections were created and stained with hematoxylin and eosin which showed fibrinous material and plenty of red blood cells [Figure - 1]D. The cell smear was air dried, and stained with Giemsa, Congo red, Hematoxylin and Eosin stains. There were no malignant cells or lymphocytes seen in any of the smears which ruled out masquerade syndromes such as reticulum cell sarcoma. Primary familial amyloidosis can present with perivasculitis and bilateral vitreous membranes as in this case,[4] but Congo red staining was negative. Microbiological examination too was negative for any microorganisms.

The follow up at one month revealed completely cleared vitreous membranes and resolved hemorrhages and a best corrected visual acuity of 20/30 in the right eye. The patient was stable when last seen at four months of follow-up. The patient refused to undergo any intervention for the left eye.

The atypical morphological appearance of the membranes and bilaterality necessitated ruling out amyloidosis and intra ocular lymphoma. Our case illustrates that long standing vitreous hemorrhage due to a nonspecific condition such as vasculitis could present with such a striking and peculiar appearance of the vitreous with leathery membranes that necessitated cytological examination after a diagnostic and therapeutic vitrectomy.

 
  References Top

1.
Green W. The uveal tract, lymphomas. In Spencer W (ed): Ophthalmic pathology: A Text and Atlas, 4th ed, vol 3. Philadelphia, WB Saunders, 1996;1741-74.  Back to cited text no. 1
    
2.
Hirata A, Miyazaki T, Tanihara H. Intraocular infiltration of adult T-cell leukemia. Am J Ophthalmol 2002;134:616-8.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Reinhard T, Bocking A, Pomjanski N, Sundmacher R. Immune cells in the anterior chamber of patients with immune reactions after penetrating keratoplasty. Cornea 2002;21: 56-61.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.
Yanoff M, Fine BS: Vitreous. In Yanoff M, Fine BS (eds): Ocular Pathology, 5th ed. Philadelphia, Mosby, Chapter 12, p 470-471.  Back to cited text no. 4
    


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