Medial transconjunctival intrinsic optic nerve biopsy: surgical technique and indications.
OBJECTIVE
To describe a method of intrinsic optic nerve biopsy and its indications.


METHODS
Retrospective case series.


RESULTS
We report four cases that required intrinsic optic nerve biopsy for progressive optic neuropathy with uncertain diagnosis after negative systemic investigations. In all cases, a medial transconjunctival approach was used. There were no complications noted with this technique in the series, specifically there was no reported deterioration in vision. One case of neurosarcoidosis was confirmed. In the other three cases, the pathology results were non-diagnostic but ruled out serious causes such as central nervous system leukaemia relapse.


CONCLUSIONS
Medial transconjunctival intrinsic optic nerve biopsy is a minimally invasive and safe technique. The technique is suitable for sampling pathology in the distal portion of the optic nerve. Optic nerve biopsy is indicated when there is significant loss of vision from an isolated optic nerve disease and all systemic investigations have failed to identify the cause, or where the clinical course of a presumed diagnosis is atypical.
The Royal Victorian Eye and Ear Hospital, Orbital Plastics and Lacrimal Unit, Melbourne, Australia. jwujin.khong@eyeandear.org.au
Jwu Jin
JJ
Khong
Alan A
AA
McNab
D000328:Adult; D001706:Biopsy / Q000379:methods; D002493:Central Nervous System Diseases / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D003228:Conjunctiva; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D009900:Optic Nerve / Q000187:drug effects / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000188:drug therapy; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D055815:Young Adult
D005938:Glucocorticoids; D016756:Immunoglobulins, Intravenous; D008775:Methylprednisolone