Subretinal lavage during diagnostic vitrectomy: an adjunctive technique for cell sampling in suspected vitreoretinal lymphoma

Purpose: Current diagnostic methods for vitreoretinal lymphoma (VRL) with predominant subretinal involvement exhibit limited sensitivity. We introduce a novel subretinal lavage technique intended to enhance diagnostic yields during vitrectomy procedures. Methods: During diagnostic vitrectomy, 0.1-0.3 ml of balanced saline solution (BSS) is injected into the subretinal space, creating a localized retinal detachment. Immediately thereafter, the diluted cellular suspension is gently aspirated manually using a 41-gauge extendable soft needle. Results: The technique was successfully performed in three patients without complications, consistently yielding approximately 0.3 ml of lymphoma cell-enriched fluid. Cytological analysis confirmed the presence of CD20-positive B lymphocytes and the MYD88 L265P mutation in all cases. Vitreous cytology was concurrently positive in two out of the three patients. Conclusions: Subretinal lavage is a safe, straightforward, and effective adjunct to standard vitreous biopsy, significantly improving diagnostic accuracy in VRL cases characterized by predominant subretinal infiltration. Implementation of this technique may lead to improved clinical decision-making and patient outcomes.