title: Retinal and choroidal biopsies are helpful in unclear uveitis of suspected infectious or malignant origin.
abstract: OBJECTIVE
  To assess the clinical value of retinal or choroidal biopsy in establishing a definitive diagnosis directing subsequent management and to assess the risk involved in such surgery.
  
  
  METHODS
  Retrospective noncomparative interventional case series.
  
  
  METHODS
  Thirteen patients with uveitis of suspected malignant or infectious origin. One patient had 2 consecutive biopsies on the same eye.
  
  
  METHODS
  A retrospective review of a 4-year period was undertaken of all those cases in which the biopsy was taken for diagnostic purposes at a single institution.
  
  
  METHODS
  Ability of biopsy to establish a pathologic diagnosis and guide treatment and surgical complications.
  
  
  RESULTS
  A transscleral approach was used in 4 and a pars plana vitrectomy approach in 10 of the biopsies. The only operative complication was a retinal break in 1 case. Postoperative events that might be related to the surgery included 1 localized retinal detachment, 2 cataracts, and 1 phthisical eye. The pathologic diagnosis differed from the initial clinical diagnosis in 5 of the 13 cases. The biopsy result directed specific appropriate treatment in 7 of the 13 cases. In the 6 remaining cases, no specific diagnosis was confirmed, but the results of the biopsy were useful in excluding malignancy and in some cases allowing a therapeutic trial.
  
  
  CONCLUSIONS
  Retinal or choroidal biopsy is a valuable investigation that often changes clinical management when carried out for specific indications in patients with uveitis of suspected malignant or infectious origin. Although it is likely to remain an investigation of last resort, it should be considered at an earlier stage when there is diagnostic uncertainty if severe visual loss is to be prevented.
authors.affiliation: Moorfields Eye Hospital, City Road, London, United Kingdom. rob.johnston@egnhst.org.uk
authors.forename: Robert L
authors.initials: RL
authors.lastname: Johnston
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
authors.forename: Susan
authors.initials: S
authors.lastname: Lightman
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Luthert
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Pavesio
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Cooling
authors.forename: David
authors.initials: D
authors.lastname: Charteris
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002829:Choroid / Q000473:pathology*; D003131:Combined Modality Therapy; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012160:Retina / Q000473:pathology*; D012189:Retrospective Studies; D014126:Toxoplasmosis, Ocular / Q000175:diagnosis* / Q000628:therapy; D015866:Uveitis, Posterior / Q000175:diagnosis*; D014821:Vitrectomy / Q000379:methods