Simplified Clinic-Based Vitreous Biopsy Technique Using A Vitreous Cutter and Manual Actuation

Abstract

Purpose : Vitreous biopsy is important for the diagnosis and management of endophthalmitis, malignancy, and uveitis. However, clinic-based vitreous biopsies using a 25-gauge needle without cutting capability are limited by a significant rate of either dry or suboptimal samples. Our prior work demonstrated an in-office vitreous biopsy with a standard dual drive pneumatic cutter manually actuated with two syringes. Although this allows reliable vitreous biopsies, the setup is somewhat complex, limiting its use in a high volume clinic. Here we demonstrate a simplified technique, more amenable for daily clinic use, which uses a vitreous cutter with a single drive line and pre-installed luer lock fittings (Figures 1-2). This greatly simplifies assembly and improves ease of use for the clinic setting.

Methods : In the clinic setting, the patient’s eye is anesthetized and prepped. A trocar is used to place a pars plana cannula. In a sterile field, a 10-cc syringe is connected to the drive line and a 1cc syringe is connected to the aspiration line of the cutter. The cutter is inserted into the vitreous via the cannula system. The assistant manually actuates the cutter with the 10-cc syringe while the physician aspirates vitreous. Once the sample is collected, the cutter is removed from the eye. Any necessary intravitreal injections are provided. The trocar is removed with forceps.

Results : Successful vitreous biopsy is demonstrated using this technique with a 25-gauge bi-blade vitreous cutter and single manual drive line in the office setting.

Conclusions : In-office vitreous biopsy can be performed using a trocar-cannula system with manual actuation of a vitreous cutter. This can be performed with either 25-gauge or 27-gauge instrumentation. Improvements to the technique include rapid assembly with use of a single drive line cutter provided with luer lock components. This simplifies the ability to use this setup for patient care in the clinic. High quality vitreous samples in the clinic hold promise for improved diagnostic capability and proteomic analysis of samples.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Figure 1: Mechanism of action of single drive vitreous cutter. A syringe is used to push air and close the cutter (top image). Once the pressure has been released from the syringe, the spring returns and opens the cutter (bottom image).

 

Figure 2. Assembled vitreous cutter.