title: Intraocular biopsy using special forceps: a new instrument and refined surgical technique.
abstract: OBJECTIVE
  The aim was to investigate the Essen biopsy forceps as a new instrument and surgical approach for biopsy of intraocular tumours. Biopsy is indicated for assessment of any uncertain intraocular process or confirmation for presumed diagnosis before treatment. There is increasing interest for further genetic and immunocytological information in order to characterise the neoplasm, especially grading and prognosis of micrometastasis in uveal melanoma. The authors have developed a new surgical technique using special intraocular biopsy forceps.
  
  
  METHODS
  Twenty patients with uncertain intraocular subretinal tumour underwent biopsies carried out using the special Essen biopsy forceps. Biopsies were obtained through sutureless 23-gauge three-port vitrectomy. A small retinotomy tumour specimen was taken by the forceps branches. For further processing, the specimens were flushed out into a sterile tube and then sent to pathologists.
  
  
  RESULTS
  The prebioptical tumour had a mean thickness of 3.48 mm (1.1 to 9.8 mm). In all cases (n=20) biopsies (0.3-2.1 mm in size) were obtained, in 19 cases (95%) allowing precise histological and immunohistochemical typing of the lesions following cytoblock embedding. Uveal melanoma was diagnosed in 50% (n=10), choroidal metastasis in 15% (n=3) and choroidal naevus in 15% (n=3); other diagnoses (n=3) included choroidal haemangioma, B cell lymphoma and old subretinal haemorrhage. Apart from three patients with temporary punctual bleeding on the surface, there were no intra- and postoperative complications.
  
  
  CONCLUSIONS
  Biopsy using special forceps is a promising new approach and precise surgical procedure. Especially for small intraocular tumours, this technique has the advantage in providing enough tissue for improved histological examination and presenting a low risk for complications.
authors.affiliation: Department of Ophthalmology, University of Duisburg-Essen, Hufelandstraße 55, Essen 45147, Germany. harun.akguel@web.de
authors.forename: Harun
authors.initials: H
authors.lastname: Akgul
authors.forename: Friedrich
authors.initials: F
authors.lastname: Otterbach
authors.forename: Norbert
authors.initials: N
authors.lastname: Bornfeld
authors.forename: Bernhard
authors.initials: B
authors.lastname: Jurklies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000295:instrumentation* / Q000379:methods; D005123:Eye / Q000473:pathology*; D005134:Eye Neoplasms / Q000098:blood supply / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008545:Melanoma / Q000098:blood supply / Q000473:pathology*; D008875:Middle Aged; D009506:Nevus / Q000098:blood supply / Q000473:pathology*; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation / Q000379:methods; D013525:Surgical Instruments