One case series demonstrated that two-thirds of patients had progression to no light perception vision within 1 month of diagnosis [29].

37.7 Conclusion

Both cancer and cancer treatment lead to an immunocompromised state, making cancer patients particularly susceptible to opportunistic viral infections. Appropriate screening for sight-threatening viral retinitis in cancer patients is of utmost importance. Prompt recognition of disease and prompt treatment will help to improve visual outcomes and quality of life for cancer patients.

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Chapter 38

Diagnostic Vitrectomy and the Cancer Patient:

Special Considerations

Garvin H. Davis, Gibran S. Khurshid, Kapil G. Kapoor, and Bernard F. Godley

Abstract The term diagnostic vitrectomy is used to refer to biopsy of the vitreous or the uvea. In patients with a history of cancer, there is a low clinical threshold for diagnostic vitrectomy as vitritis can represent recurrence of lymphoma or leukemia or an opportunistic infection. The most common clinical scenarios in which diagnostic vitrectomy is performed in cancer patients are new-onset vitreous cellularity in a patient with lymphoma in remission or newly diagnosed lymphoma; vitritis in a patient with recent bone marrow transplantation; atypical retinitis or choroiditis; and atypical iris, ciliary body, or choroidal lesions. In addition, choroidal biopsy is sometimes done to obtain material for cytogenetic studies in patients with uveal melanoma. Vitreous biopsy can be performed successfully with either a two-port or three-port approach; specifics of the technique depend on the vitrector gauge. Uveal biopsy can be performed with fine-needle aspiration biopsy or with transretinal choroidal biopsy with a sutureless vitrectomy system, an approach that is gaining favor. Collaboration and good communication between the ophthalmologist and a pathologist well versed in the handling and analysis of vitreous samples are essential for successful diagnostic vitrectomy.

38.1 Introduction

Diagnostic vitrectomy in cancer patients is used in a wide range of clinical scenarios (Fig. 38.1). Patients with a history of cancer may experience decreased vision or other visual symptoms associated with vitreous hemorrhage, vitritis, retinitis, and/or chorioretinitis. These presentations pose diagnostic challenges, as they can signify a primary intraocular, primary extraocular, or metastatic malignancy; the recurrence of a malignancy; and even a paraneoplastic syndrome or conditions unrelated to

G.H. Davis (B)

Department of Ophthalmology, The University of Texas at Houston, Houston, TX, USA e-mail: gdavis@uth.tmc.edu

Oncology Series 6, DOI 10.1007/978-1-4419-0374-7_38,

C Springer Science+Business Media, LLC 2011

472

Fig. 38.1 Most common causes of posterior segment disease in cancer patients requiring diagnostic vitrectomy. CMV, cytomegalovirus; HSV, herpes simplex virus; HZV, herpes zoster virus

.al et Davis .H.G