AAO 2020 Video Program

    In this video, the authors present their technique for transvitreal biopsy using a 25-gauge cutter of a newly identified choroidal tumor in the setting of a rhegmatogenous retinal detachment (RRD). The patient is a 66-year-old man who presented for vision loss for one month. Examination revealed a macula-involving retinal detachment with a single inferior break, as well as a 12x12x3-mm amelanotic choroidal tumor in the posterior pole. After a scleral buckle, the 25-gauge cutter was advanced directly into the choroidal lesion, and the sample was obtained on aspiration with a low cut rate. The sample was then refluxed into an Eppendorf tube and confirmed under the microscope. The retinal detachment was then subsequently repaired. Cytopathology of the specimen returned metastatic hepatocellular carcinoma, which is an exceedingly rare cause of choroidal metastasis. This transvitreal approach with a 25-gauge cutter instead of fine aspiration with a needle provides several advantages, including safe management of the retinal detachment, collection of a larger sample size, direct visualization and a theoretically lower risk of seeding.