Aspiration cutter-assisted anterior segment tumor biopsy appears safe, effective

This retrospective case series published in the November issue of the American Journal of Ophthalmology reports the results and complications of aspiration cutter-assisted anterior segment tumor biopsy performed under viscoelastic. The results suggest that small-incision, aspiration cutter-assisted iris and iridociliary tumor biopsy is a safe and effective procedure.

The authors used the previously reported Finger iridectomy technique and expanded their report to include 56 biopsies from 55 patients. There were 52 samples from patients followed for at least one month. The largest number of cases were suspected iris melanoma in 39 patients, followed by suspicious iris nevi in four and melanocytoma in four. Median follow-up was 30 months.

Indications for biopsy included suspected anterior segment malignancy, patient desire for pathologic confirmation before treatment, atypical tumor and genetic tumor analysis. The procedure involved placement of a 25-gauge aspiration cutter through a juxtalimbal corneal 25-gauge paracentesis. Settings were adjusted to maximize the efficiency of the process. Two or three biopsies were taken and the contents aspirated in a 3-mL syringe.

There was no change in visual acuity one month after the procedure. Seven wounds (13.4 percent) required a single 10-0 nylon suture to achieve negative Seidel test results at the corneal entry site. Complications included transient elevated IOP (in 11.5 percent) and one case each of hyphema, flare and persistent pupillary defect. Except for the pupillary defect, these all resolved within four weeks of biopsy.

Further treatment was required in 45 patients. There were no secondary infections or cataracts. To date, the authors report no loss of vision, infection, tumor recurrences or metastases related to the biopsy procedure.