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• W2153269110 abstract "The following two letters address an article that appeared in the December 1999 issue of the Journal:Akpek EK, Maca SM, Christen WG, Foster CS. Elevated vitreous interleukin-10 level is not diagnostic of intraocular-central nervous system lymphoma. Ophthalmology 1999;106:2291–5.Dear Editor: The diagnosis of intraocular lymphoma remains problematic; false-negative diagnostic vitrectomies for the disease are common. Therefore new diagnostic approaches for this disorder are needed. Akpek et al1Shen D.F. Zhuang Z. LeHoang P. et al.Utility of microdissection and polymerase chain reaction for the detection of immunoglobulin gene rearrangement and translocation in primary intraocular lymphoma.Ophthalmology. 1998; 105: 1664-1669Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar stated that measurement of interleukin (IL)-10 and IL-6 levels in the vitreous is a helpful tool for the diagnosis of primary intraocular B cell lymphoma. The title of this article is misleading, because four of four lymphoma patients showed elevated IL-10 levels in their vitreous and one of one patient also had an IL-10-to-IL-6 ratio of 20 (there were no IL-6 levels in the vitreous of the other three patients).Over the past 10 years, we have tried to develop techniques to improve the sensitivity and specificity of vitrectomy for the diagnosis of intraocular lymphoma. Prompt processing of the vitreous specimen is critical to diagnosis. Lymphoma cells start to degenerate within minutes, and an experienced cytologist is required to interpret the vitreous samples for the correct diagnosis. In addition, we have found elevations of IL-10 and high ratios of IL-10 to IL-6 in the vitreous sample increase the likelihood of the presence of lymphoma cells in the eye. In 10 of 10 vitreous biopsies from our patients with primary intraocular B cell lymphoma, there were elevations of IL-10 levels (158–5120 pg/ml or more) and higher IL-10-to-IL-6 ratios were detected. In 10 of 10 cases from our series, plus another 10 cases from the National Eye Institute in the United States (60–14,000 pg/ml; Chan, unpublished data), the diagnosis of lymphoma was confirmed not only by the elevation of IL-10 but also by the presence of lymphoma cells in the vitreous and the IgH gene rearrangement in the lymphoma cells.1Shen D.F. Zhuang Z. LeHoang P. et al.Utility of microdissection and polymerase chain reaction for the detection of immunoglobulin gene rearrangement and translocation in primary intraocular lymphoma.Ophthalmology. 1998; 105: 1664-1669Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar This observation is in accord with the previous reports from the NEI2Chan C.C. Whitcup S.M. Solomon D. Nussenblatt R.B. Interleukin-10 in the vitreous of patients with primary intraocular lymphoma.Am J Ophthalmol. 1995; 120: 671-673Abstract Full Text PDF PubMed Scopus (158) Google Scholar, 3Buggage RR, Whitcup SM, Nussenblatt RB, Chan CC. Using interleukin 10 to interleukin 6 ratio to distinguish primary intraocular lymphoma and uveitis. [letter] Invest Ophthalmol Vis Sci 1999;40:2462–3. Comment on: Invest Ophthalmol Vis Sci 1998;39:2659–65.Google Scholar, 4Whitcup S.M. Stark-Vancs V. Wittes R.E. et al.Association of interleukin 10 in the vitreous and cerebrospinal fluid and primary central nervous system lymphoma.Arch Ophthalmol. 1997; 115: 1157-1160Crossref PubMed Scopus (158) Google Scholar and the presence of IL-10 mRNA in lymphoma cells.5Chan CC, Shen DF. Newer methodologies in immunohistochemistry and diagnosis. In: BenEzra D, ed. Uveitis Update. New York: Karger, 1999;1–13 (Dev Ophthalmol Ser; 31).Google ScholarFinally, immunologic and molecular analysis of the vitreous specimens has aided us in the diagnosis of intraocular lymphoma. Failure to identify the malignant cells in vitreous specimens does not completely exclude the diagnosis of primary intraocular B cell lymphoma, although pathologic demonstration of lymphoma cells are necessary for making the diagnosis. We have performed repeat vitrectomy on suspected patients. We have also found positive IgH gene rearrangements on suspected specimens with atypical lymphocytes and later confirmed the diagnosis. Any advance in the diagnosis of intraocular lymphoma should benefit patient care, because prompt diagnosis and early therapy can improve the prognosis in this potentially lethal disorder. We believed that vitreous IL-10 and IL-6 levels are helpful for the diagnosis of primary intraocular B cell lymphoma and suggest that Akpek et al perform a second diagnostic vitrectomy on the two patients with uveitis and high vitreous IL-10 levels (patients 1, 3, and 12). The following two letters address an article that appeared in the December 1999 issue of the Journal: Akpek EK, Maca SM, Christen WG, Foster CS. Elevated vitreous interleukin-10 level is not diagnostic of intraocular-central nervous system lymphoma. Ophthalmology 1999;106:2291–5. Dear Editor: The diagnosis of intraocular lymphoma remains problematic; false-negative diagnostic vitrectomies for the disease are common. Therefore new diagnostic approaches for this disorder are needed. Akpek et al1Shen D.F. Zhuang Z. LeHoang P. et al.Utility of microdissection and polymerase chain reaction for the detection of immunoglobulin gene rearrangement and translocation in primary intraocular lymphoma.Ophthalmology. 1998; 105: 1664-1669Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar stated that measurement of interleukin (IL)-10 and IL-6 levels in the vitreous is a helpful tool for the diagnosis of primary intraocular B cell lymphoma. The title of this article is misleading, because four of four lymphoma patients showed elevated IL-10 levels in their vitreous and one of one patient also had an IL-10-to-IL-6 ratio of 20 (there were no IL-6 levels in the vitreous of the other three patients). Over the past 10 years, we have tried to develop techniques to improve the sensitivity and specificity of vitrectomy for the diagnosis of intraocular lymphoma. Prompt processing of the vitreous specimen is critical to diagnosis. Lymphoma cells start to degenerate within minutes, and an experienced cytologist is required to interpret the vitreous samples for the correct diagnosis. In addition, we have found elevations of IL-10 and high ratios of IL-10 to IL-6 in the vitreous sample increase the likelihood of the presence of lymphoma cells in the eye. In 10 of 10 vitreous biopsies from our patients with primary intraocular B cell lymphoma, there were elevations of IL-10 levels (158–5120 pg/ml or more) and higher IL-10-to-IL-6 ratios were detected. In 10 of 10 cases from our series, plus another 10 cases from the National Eye Institute in the United States (60–14,000 pg/ml; Chan, unpublished data), the diagnosis of lymphoma was confirmed not only by the elevation of IL-10 but also by the presence of lymphoma cells in the vitreous and the IgH gene rearrangement in the lymphoma cells.1Shen D.F. Zhuang Z. LeHoang P. et al.Utility of microdissection and polymerase chain reaction for the detection of immunoglobulin gene rearrangement and translocation in primary intraocular lymphoma.Ophthalmology. 1998; 105: 1664-1669Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar This observation is in accord with the previous reports from the NEI2Chan C.C. Whitcup S.M. Solomon D. Nussenblatt R.B. Interleukin-10 in the vitreous of patients with primary intraocular lymphoma.Am J Ophthalmol. 1995; 120: 671-673Abstract Full Text PDF PubMed Scopus (158) Google Scholar, 3Buggage RR, Whitcup SM, Nussenblatt RB, Chan CC. Using interleukin 10 to interleukin 6 ratio to distinguish primary intraocular lymphoma and uveitis. [letter] Invest Ophthalmol Vis Sci 1999;40:2462–3. Comment on: Invest Ophthalmol Vis Sci 1998;39:2659–65.Google Scholar, 4Whitcup S.M. Stark-Vancs V. Wittes R.E. et al.Association of interleukin 10 in the vitreous and cerebrospinal fluid and primary central nervous system lymphoma.Arch Ophthalmol. 1997; 115: 1157-1160Crossref PubMed Scopus (158) Google Scholar and the presence of IL-10 mRNA in lymphoma cells.5Chan CC, Shen DF. Newer methodologies in immunohistochemistry and diagnosis. In: BenEzra D, ed. Uveitis Update. New York: Karger, 1999;1–13 (Dev Ophthalmol Ser; 31).Google Scholar Finally, immunologic and molecular analysis of the vitreous specimens has aided us in the diagnosis of intraocular lymphoma. Failure to identify the malignant cells in vitreous specimens does not completely exclude the diagnosis of primary intraocular B cell lymphoma, although pathologic demonstration of lymphoma cells are necessary for making the diagnosis. We have performed repeat vitrectomy on suspected patients. We have also found positive IgH gene rearrangements on suspected specimens with atypical lymphocytes and later confirmed the diagnosis. Any advance in the diagnosis of intraocular lymphoma should benefit patient care, because prompt diagnosis and early therapy can improve the prognosis in this potentially lethal disorder. We believed that vitreous IL-10 and IL-6 levels are helpful for the diagnosis of primary intraocular B cell lymphoma and suggest that Akpek et al perform a second diagnostic vitrectomy on the two patients with uveitis and high vitreous IL-10 levels (patients 1, 3, and 12). Author’s replyOphthalmologyVol. 108Issue 3Preview Full-Text PDF" @default.
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