June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Surgical Techniques, Indications, and Outcomes of Transvitreal Biopsy for Uveal Melanoma
Author Affiliations & Notes
  • Laura Snyder
    Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Anthony B Daniels
    Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States
    Vanderbilt-Ingram Cancer Center and Departments of Cancer Biology and Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Footnotes
    Commercial Relationships   Laura Snyder, None; Anthony Daniels, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 4404. doi:
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      Laura Snyder, Anthony B Daniels; Surgical Techniques, Indications, and Outcomes of Transvitreal Biopsy for Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4404.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Controversy exists regarding the best method for biopsy of uveal melanoma (UM). We aim to evaluate the success and safety of a novel transvitreal biopsy technique by retrospectively evaluating the characteristics of tumors for which the procedure was performed, complications from the procedure and success for obtaining sample for prognostic genetic profiling

Methods : Medical records for 100 consecutive cases of UM diagnosed between 2013 and 2016 were reviewed. Records were analyzed for tumor size, location, primary treatment, method of biopsy and any complications thereof. Patients were stratified by treatment modality and biopsy status. Characteristics of patients who underwent biopsy were noted including examination of tumor size, location, or presence of subretinal fluid; to see if these affected surgeon preference for biopsy modality.

Results : Ninety-nine consecutive patients aged 24.6 – 88.6 years (mean 63.1) were diagnosed with 100 UMs (one eye had 2 melanomas). There were 39 small, 31 medium, and 29 large tumors at diagnosis with the majority (n=60) posterior to the equator. Fifty-two patients underwent biopsy (26 transvitreal, 22 transscleral, 4 transcorneal). Transvitreal biopsies were more common in patients with small (n=15; p<0.0001), posterior (n=18; p<0.0001) tumors. Of the 26 patients who had transvitreal biopsy, intraoperatively 20 (76.9%) had a clot or small trickle of blood at the biopsy site, 8 (30.8%) had small localized subretinal hemorrhage, 4 (15.4%) had small vitreous hemorrhage, and 1 (3.8%) had small choroidal detachments. When subretinal hemorrhage occurred, it was almost always into a pre-existing pocket of subretinal fluid (p=0.0093). However, the presence of subretinal fluid was not associated with the decision to proceed with any biopsy (p=0.36) or transvitreal biopsy specifically (p=1.00) By 3 months, almost all subretinal and vitreous hemorrhage resolved. There were no cases of iatrogenic retinal detachment or extraocular tumor spread. Gene expression profiling class could be determined in all samples.

Conclusions : This technique is best used for small or posterior tumors, or small anterior tumors. Complications were minor, and yields for genetic prognosis were adequate in all cases. The presence of subretinal fluid is a relative contraindication, because it may lead to subretinal hemorrhage in the fluid pocket.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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