The ocular consequences and applicability of minimally invasive 25-gauge transvitreal retinochoroidal biopsy

Abstract

Objective: To determine the applicability and ocular morbidity of the 25-gauge transvitreal retinochoroidal biopsy technique in the management of intraocular tumors.

Design: Retrospective, consecutive, observational, single-surgeon case series.

Participants: A total of 124 biopsies were performed in 123 patients with intraocular tumors in the posterior segment from January 1, 2009, through December 31, 2011.

Methods: The biopsies were performed under general anesthesia with standard 25-gauge vitrectomy equipment. The vitreous body and the retinotomies were left untreated with the exception of 1 patient in whom a complete vitrectomy and oil tamponade were performed. Histopathologic examination of all samples was performed and cytogenetic testing with fluorescence in situ hybridization and multiplex ligation-dependent probe amplification were performed in the uveal melanomas. Median follow-up time was 26.3 months (range, 2.0-47.2 months).

Main outcome measures: Histopathologic diagnosis and chromosome 3 analysis of the biopsy-obtained tissue sample. Clinical observations included visual acuity, retinal detachment, vitreous hemorrhage, and secondary enucleation.

Results: Histopathologic diagnosis was obtained in 97.6% (n = 121) of the intraocular tumors, and chromosome 3 status could be determined in 97.3% (n = 110) of uveal melanoma patients. Preoperative retinal detachment was present in 65% (n = 55). Apart from in 1 case, all retinal detachments remained stable during surgery. Additionally, 7.1% (n = 6) of cases demonstrated retinal detachment during the follow-up period, and vitreous hemorrhage was observed in 96.5% of cases (n = 82) 1 day after surgery. Both conditions regressed spontaneously in nearly all cases. Retinal detachment surgery and vitrectomy resulting from persistent vitreous hemorrhage was performed in 3.5% (n = 3) and 5.9% (n = 5) of patients, respectively. The frequency of secondary enucleated eyes was 6.7% (n = 5). Free tumor cells after biopsy were described in 15.9% (n = 7), but no tumor recurrence at the sclerotomy sites was observed. A decrease in visual acuity from better than 0.1 (20/200) at diagnosis to 0.1 or worse at 1 and 3 years of follow-up was observed in 21.7% (n = 13) and 41.7% (n = 5) of patients, respectively.

Conclusions: The 25-gauge transvitreal retinochoroidal biopsy provides a large sample, adequate for histopathologic examination and cytogenetic analysis. The procedure is associated with a low risk of ocular complications.