Intraocular biopsy using special forceps: a new instrument and refined surgical technique

• Published in: British journal of ophthalmology Vol. 95; no. 1; pp. 79 - 82
• Main Authors: Akgul, Harun, Otterbach, Friedrich, Bornfeld, Norbert, Jurklies, Bernhard
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.01.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biopsy - instrumentation; Biopsy - methods; Choroid; diagnostic tests/investigation; Eye - pathology; Eye Neoplasms - blood supply; Eye Neoplasms - pathology; Female; forceps; histology; Humans; Immunohistochemistry; intraocular biopsy; intraocular tumour; Male; Medical sciences; Melanoma; Melanoma - blood supply; Melanoma - pathology; Metastasis; Middle Aged; Miscellaneous; neoplasia; Nevus - blood supply; Nevus - pathology; ocular oncology; Ophthalmologic Surgical Procedures - instrumentation; Ophthalmologic Surgical Procedures - methods; Ophthalmology; pathology; Skin cancer; Surgical Instruments; Surgical techniques; treatment surgery; Tumors; uveal melanoma; Treatment; Intraocular; Biopsy; Surgery; Ophthalmology; Technique; Forceps
• ISSN: 0007-1161; 1468-2079
• DOI: 10.1136/bjo.2008.148395

AimThe aim was to investigate the Essen biopsy forceps as a new instrument and surgical approach for biopsy of intraocular tumours. Biopsy is indicated for assessment of any uncertain intraocular process or confirmation for presumed diagnosis before treatment. There is increasing interest for further genetic and immunocytological information in order to characterise the neoplasm, especially grading and prognosis of micrometastasis in uveal melanoma. The authors have developed a new surgical technique using special intraocular biopsy forceps.MethodsTwenty patients with uncertain intraocular subretinal tumour underwent biopsies carried out using the special Essen biopsy forceps. Biopsies were obtained through sutureless 23-gauge three-port vitrectomy. A small retinotomy tumour specimen was taken by the forceps branches. For further processing, the specimens were flushed out into a sterile tube and then sent to pathologists.ResultsThe prebioptical tumour had a mean thickness of 3.48 mm (1.1 to 9.8 mm). In all cases (n=20) biopsies (0.3–2.1 mm in size) were obtained, in 19 cases (95%) allowing precise histological and immunohistochemical typing of the lesions following cytoblock embedding. Uveal melanoma was diagnosed in 50% (n=10), choroidal metastasis in 15% (n=3) and choroidal naevus in 15% (n=3); other diagnoses (n=3) included choroidal haemangioma, B cell lymphoma and old subretinal haemorrhage. Apart from three patients with temporary punctual bleeding on the surface, there were no intra- and postoperative complications.ConclusionsBiopsy using special forceps is a promising new approach and precise surgical procedure. Especially for small intraocular tumours, this technique has the advantage in providing enough tissue for improved histological examination and presenting a low risk for complications.