A 66-year-old woman has six months of bilateral painless blurring with floaters. Examination shows vitreous cells and faint creamy sub-retinal pigment epithelial infiltrates in both eyes. Corticosteroids give only transient improvement. What is the most appropriate next step?

• A Diagnostic vitrectomy with cytology and interleukin-10 estimation ✓
• B Serum angiotensin converting enzyme level and chest imaging
• C Fluorescein angiography to look for staining of the infiltrates
• D Empirical four-drug antitubercular therapy

Explanation

Bilateral vitritis with sub-RPE infiltrates in an older patient responding poorly to steroids is primary vitreoretinal lymphoma, a masquerade syndrome. Diagnosis rests on cytology of vitreous samples showing malignant lymphoid cells, supported by a raised interleukin-10 to interleukin-6 ratio in the vitreous. Sarcoid workup and empirical antitubercular therapy delay definitive care, and angiographic staining is nonspecific because many choroidopathies stain.

Reference: Yanoff and Duker, Ophthalmology, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.