Abstract
Purpose :
Ciliary body tumors remain a diagnostic challenge for eye cancer specialists. This is because the ciliary body contains a spectrum of progenitor cell types and thus a multitude of possible diagnoses. When ciliary body tumors do not extend through the iris root, their posterior location prevents direct visualization. In these cases, a clinical diagnosis may not be possible leading to a decision for biopsy. Prior biopsy methods typically include: scleral dissection, which has been associated with risk of scleral weakening, tumor dissemination and retinal detachment, or sharp-needle aspiration biopsy with manual aspiration which risks laceration of nearby structures as well as hyphema and glaucoma. The purpose of this study is to report the outcomes of a new minimally invasive, micro-incision, trans-corneal biopsy technique for ciliary body tumors.
Methods :
We performed a retrospective, interventional clinical study. Five atypical ciliary body tumors underwent biopsy for histopathology and immunohistochemical analysis. Biopsy involved making a 1 mm clear cornea incision to allow injection of viscoelastic to form and maintain the anterior chamber. Then a 27-gauge aspiration-cutter was inserted into the anterior chamber. The aspiration-cutter was used to make an iridotomy at the iris root, through which it was extended into the ciliary tumor. A cut rate of 300 cuts per minute and aspiration at 600 mmHg was used to retrieve tumor samples into 3-cc syringes. A mean 3.8 passes were utilized to obtain tumor tissue.
Results :
Diagnostic specimens were obtained in all cases and used for cytological, histological and immunohistochemical analysis. Diagnosis based on biopsy specimens was made in 4/5 (80%) cases. Diagnoses included melanoma (60%), melanocytoma (20%), and leiomyoma (20%). There was no biopsy related glaucoma, infection, cataract, or vision loss. Transient, short duration (< 1 week) hyphema was noted in 3 cases.
Conclusions :
This novel application of the “Finger Iridectomy Technique” offers several key advantages. It is performed through a self-sealing clear corneal incision that did not require sutures. The blunt tipped 27-gauge aspiration and cutting were modulated by a foot-pedal and voice-command. This minimally invasive aspiration-cutter technique was an effective method to obtain ciliary body biopsies to provide diagnostic information without significant complications.
This is a 2020 ARVO Annual Meeting abstract.