RetinaLink Feature Video: Subretinal Biopsy to Diagnose Subretinal Infiltrate from Dr. Sean D. Adrean

RetinaLink is pleased to feature Sean D. Adrean MD, FAAO, Retina Consultants of Orange County, Fullerton and Los Alamitos, CA. Dr. Adrean shared two interesting videos in 2018 highlighting, Autologous Retinal Transplant in his patient with previous Macular Hole & AMD and Case of Mayhem. His latest video with voiceover is a case of a subretinal biopsy to diagnose the cause of a subretinal infiltrate in his 68-year-old male patient’s left eye.


Sean Adrean, MD, FAAO

SUMMARY:
A previous vitreous biopsy had been performed and the result was non-specific inflammatory material. At this time, the patient’s VA was 20/25.

Several months later, his vision changed as well as multiple changes occurred in both his retina and on his lens surface.

Pre-op VA: 20/200.

It was difficult for me to locate a good site to biopsy. I had hoped to remove to all subretinal exudative material during the biopsy and push it away from the central fovea. My initial preference was to remove all the exudative material.

I determined it was best to use 25-gauge soft tip cannula and PERFLUORON® perfluorocarbon liquid to get a better sample and planned to displace subretinal material. However, it was very difficult to capture the material. I switched to a 39-gauge to remove this material and was able to get several aliquots to capture a pure sample. There was some infusion going under retina which created a retinal detachment. The detachment also liberated some of the subretinal material. Successfully, the material was removed but, some remained so I added silicone oil.

Plan: Send all to samples to laboratory for cytology and flow cytometry.

Dx: Patient did indeed have intraocular lymphoma and the proper course of treatment was initiated.

Post-op VA: 20/40 with glasses and silicone oil

Treatment: High dose methotrexate since the patient had some brain involvement.

Dr. Adrean can be reached via e-mail – seadrean@yahoo.com

NOTE: No relevant disclosures.

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