Cytopathology of vitreous specimens in acute retinal necrosis

• Type of Material: Article
• Authors: Sara Hojjatie, University of Washington; Jessica Shantha, Emory University; Ghazala O'Keefe, Emory University; Colleen S Kraft, Emory University; Alfredo Voloschin, Emory University; Hans Grossniklaus, Emory University; Steven Yeh, Emory University
• Language: English
• Date: 2021-07-09
• Publisher: Taylor & Francis
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Rights managed by Taylor & Francis
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): https://doi.org/10.1080%2F09273948.2021.1922926
• Title of Journal or Parent Work: Ocular Immunology and Inflammation
• Volume: 30
• Issue: 7-8
• Start Page: 1609
• End Page: 1616
• Grant/Funding Information: This project was supported by the National Eye Institute/National Institutes of Health core grant P30-EY06360 (Department of Ophthalmology, Emory University School of Medicine), National Eye Institute of the National Institutes of Health under award number K23 EY030158 (Shantha) and R01 EY029594 (Yeh). This research was also supported an unrestricted departmental grant from Research to Prevent Blindness, Inc. to the Emory Eye Center, Emory University School of Medicine, the Bayer Global Ophthalmology Awards Program, Association for Research in Vision and Ophthalmology Mallinckrodt Young Investigator Award (SY), and National Institutes of Health funding for the Emory Center for AIDS Research (Kraft, P30AI050409)
• Keywords: pars plana vitrectomy; ARN; vitreous specimens; cytopathology; acute retinal necrosis
• Research Categories: Health Sciences, Opthamology; Health Sciences, Rehabilitation and Therapy

Abstract

Purpose: To report the cytopathology of vitreous biopsy samples in patients with acute retinal necrosis (ARN) who underwent pars plana vitrectomy (PPV). We also describe two patients with unique clinical courses, cytopathologic findings, and immune response Methods: A retrospective review of patients with ARN who developed retinal detachment (RD) and underwent PPV from 2011–2019 at the Emory Eye Center was performed to assess cytopathology findings of vitreous biopsy samples. Patient demographics and laboratory testing including aqueous humor PCR for viral pathogens were recorded. Additional clinical details abstracted included intravitreal injections, surgical procedures, and vitreous cytopathological reports including immunohistochemistry findings. Results: Fourteen eyes of twelve patients with RD were reviewed. Ten eyes showed HSV DNA (71%) and 4 demonstrated VZV DNA (29%). All eyes received intravitreal antivirals (i.e. ganciclovir or foscarnet) with a median of 8.5 intravitreal injections per eye. Diagnoses prompting PPV included tractional RD in 14 eyes (100%), rhegmatogenous RD in 8 eyes (57%), vitreous hemorrhage in 4 eyes (29%) and vitreous opacity in 4 (29%). Ophthalmic pathology reports showed lymphocyte populations in 10 eyes (71%) with a CD3+ T-cell predominance in two patients where immunohistochemistry of CD3+ and CD20+ for T- and B-cell populations was performed. Observed immune cell populations included macrophages or histiocytes (11 eyes, 79%) and polymorphonuclear cells in 4 eyes (29%). Initial median VA was 2.5 (IQR 2.0–3.0) and improved to 2.0 (IQR 1.48–3.00, p=0.48) at 6-months and 1.8 (IQR 1.2–3.0, p=0.45) at 12 months follow-up. Conclusions: Our cohort of ARN patients undergoing PPV show a spectrum of immunologic findings with the majority demonstrating a lymphocytic response. Histiocytes, macrophages, and PMNs were also observed. Cytopathologic and immunologic studies suggest that both innate and adaptive immunity are responsible for the clinical disease findings observed in ARN. The variability of the response to treatment in patients with ARN may reflect patient-to-patient differences in their antigen-specific immune response. Understanding the immunologic response associated with ARN may provide valuable information regarding the dosing and timing of treatment.