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CHOROIDAL TUMOR BIOPSY: A Review of the Current State and a Glance Into Future Techniques

Finn, Avni, P., MD, MBA*; Materin, Miguel, A., MD*; Mruthyunjaya, Prithvi, MD, MHS

doi: 10.1097/IAE.0000000000001997
Original Study: PDF Only

Purpose: To review the indications for and the methods of obtaining biopsies in eyes with uveal melanoma. In addition, this review provides recommendations for avoiding biopsy-related complications and discusses the future directions of biopsy techniques for uveal melanoma.

Methods: This review is based on a presentation by the authors (PM and MM) at the 2017 Duke Advanced Vitreoretinal Surgery Course and an extensive literature review using PubMed.

Results: Transscleral and transvitreal fine-needle aspiration biopsy, and transvitreal vitrectomy-assisted biopsy techniques are described. The use of 25- and 27-gauge needles and vitreous cutters through a transvitreal approach are most commonly used. Complications are uncommon but may include vitreous hemorrhage, retinal detachment, and rarely, extraocular extension. Proper technique and precautions will minimize the occurrence of these rare complications.

Conclusion: Biopsy of uveal melanoma either using a needle or vitrectomy-assisted procedures is safe and these techniques continue to improve with new vitreoretinal surgical advances.

Improvement in surgical techniques and genetic testing has led to an increase in diagnostic and therapeutic procedures on eyes with ocular tumors. In this review, we discuss the surgical techniques, ways to avoid complications, and the future of choroidal biopsies.

*Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina; and

Departments of Vitreoretinal and Macular diseases and Orbital and Ocular Oncology, Byers Eye Institute, Stanford University, Palo Alto, California.

Reprint requests: Prithvi Mruthyunjaya, MD, MHS, Byers Eye Institute, Stanford University, Palo Alto, CA 94303; e-mail: prithvi9@stanford.edu

A. P. Finn: Funding from the Heed Ophthalmic Foundation. M. A. Materin: Consultant for Castle Biosciences. P. Mruthyunjaya: Consultant for Castle Biosciences, Spark Therapeutics, and Optos and support from Research to Prevent Blindness.

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© 2018 by Ophthalmic Communications Society, Inc.