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Jerome Vincent Giovinazzo, Vincent Giovinazzo, Codrin Eugen Iacob, Richard B Rosen, Paul T Finger; Investigating the Posterior Pole: A Tool and Technique for Post Mortem Tissue Recovery. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2427.
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© 2017 Association for Research in Vision and Ophthalmology.
Retinal and choroidal histopathology is critical for disease diagnosis, treatment evaluation, and understanding anatomy and pathophysiology. Post-mortem histopathology is currently obtained through donation of whole eyes. However, patients are often resistant to donating their whole eyes to research for a variety of reasons, limiting the opportunity for advancement of histopathological study. Herein we describe a new cosmetically unobstrusive tool and technique for obtaining localized, post mortem, full thickness specimens.
A novel biopsy instrument was created using a 12mm ocular clamp welded to a 12mm cylinder. A second sharp-edged cylinder created a penetrating punch section through full thickness eye wall. The device was tested on 3 pig eyes. One with muscles detached, one with muscles and lids attached, and one with the eye still in the orbit. Through a conjunctival incision, the lateral rectus was identified and disinserted. Next, a 15mm circumferential incision was then made with a scalpel starting 5-6mm from the temporal limbus. The modified clamp was inserted part into the globe and externally into the orbit along the sclera. The two flanges were apposed, the eye wall cut, with the biopsy tissue in the punch.
Four full-thickness eye wall specimens were harvested from 3 eyes. All samples were 8-9mm in diameter and 3mm in thickness. Photographs were taken before, during and following eye wall specimen removal. All adnexal structures appeared intact and atraumatic. Histopathological examination revealed intact optic nerve and retina in situ with some areas of localized retinal detachment. Full thickness choroid and sclera pathology was available in all samples.
Successful localized postmortem eye wall specimens can be harvested using this novel but simple instrument. Donation of entire globes may not be necessary to obtain useful posterior segment pathology. The ability to remove sclera-choroidal-retinal specimens without enucleation should be more acceptable to most patients. Greater access to histopathological samples may lead to better understanding of the natural history of eye diseases and treatment effects.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
8-9mm eye wall section obtained using new tool and technique
H&E slide 2x magnification of optic nerve, sclera, choroid, and retina from specimen two
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