1. DIAGNOSTIC VITRECTOMY IN VITRITIS SECONDARY TO MYCOSIS FUNGOIDES RECURRENCE
Dra. María Paz Mendívil Soto (Oftalmología, Sección Retina)
Dra. Idoia Bearán María (Oftalmología, Sección Retina)
Dra. Estibaliz Ispizua-Mendívil (Oftalmología, MIR2 )
Dr. Juan Carlos López Duque (Anatomía Patológica)
Dra. Paloma Isusi Gorbea (Hematología - Citodiagnóstico)
Hospital de Basurto, Bilbao
Urg 27 sept

2. DIAGNOSTIC VITRECTOMY IN VITRITIS SECONDARY TO MYCOSIS FUNGOIDES RECURRENCE
67-year-old woman with a history of mycosis fungoides
Progressive unilateral vitritis in her right eye.
Clinical findings in the left eye were unremarkable, but mild vitritis was detected on OCT.
One week later vision in the right eye had further deteriorated, visual acuity was 20/200.
Right eye
Left eye

3. DIAGNOSTIC VITRECTOMY IN VITRITIS SECONDARY TO MYCOSIS FUNGOIDES RECURRENCE
Diagnostic pars plana vitrectomy was performed to obtain a sample of undilute vitreous from the right eye
Vitrectomy was incomplete due to the severe vitreous haze, which made impossible any visualization of the fundus
Sub-Tenon's triamcinolone  was injected before the end of the surgery
26 oct 2ª uveitis
IQ VPP diagnostica, 10 oct

4. Talk to the pathologist
DIAGNOSTIC VITRECTOMY IN VITRITIS SECONDARY TO MYCOSIS FUNGOIDES RECURRENCE
Microscopic examination of the vitreous fluid (vitreous cassette):
revealed a monomorphic population of atypical medium-sized lymphoid cells, kidney-shaped nuclear contours.
prompt delivery
appropriate media
Handling of the sample
correct temperature
Flow cytometry (undiluted vitreous):
abnormal immunophenotype of T lymphocytes, which in nearly 80% lacking CD3 and CD7 expression, and CD4 present, being this consistent with mycosis fungoides.
Talk to the pathologist
about the suspected diagnosis and desired testing
necessary to increase the likelihood of a diagnosis

5. Ciliar injection improved, 1 millimeter hypopion
DIAGNOSTIC VITRECTOMY IN VITRITIS SECONDARY TO MYCOSIS FUNGOIDES RECURRENCE
The patient’s dermatologist and hematologist were contacted.
Evening-fever for some days  urgent cerebral CT-scan
Hospitalized 2 weeks later due to daily evening-fever
No evidence of intracranial involvement
Treatment:
Dexamethasone drops
General treatment was palliative due to the lack of response to previous chemotherapy and radiotherapy, and was limited to oral prednisone to control fever.
Ciliar injection improved, 1 millimeter hypopion
Any questions? me at: (Estibaliz Ispizua-Mendivil)