Biopsy of intraocular tumors in clinically uncertain diagnosis

Background: Most cases of intraocular tumors can be diagnosed clinically by slitlamp examination and biomicroscopy, if needed together with noninvasive imaging techniques, such as ultrasound, angiography, CT and MRI. However a small percentage of patients remains with a clinically uncertain diagnosis. For that reason, biopsy has been used as a diagnostic modality for intraocular tumors and simulating lesions for almost 25 years. There still is an ongoing discussion about when we should perform this procedure. At our department we have been using this technique since 2003 in selected cases. The aim of this paper is to present the patients we had and the technique we used as well as the results we had. Patients and methods: 6 patients (4 with the differentialdiagnosis of choroidal melanoma vs nevus, 1 with subretinal hemorrhage and 1 with astrocytic hamartoma) have been selected for biopsy. In three cases we used a transscleral approach, three times we peformed biopsy through a transvitreal route. Results: Clinical diagnosis has been confirmed in four cases. One case had to be judged inconclusive, in one case the material obtained was not sufficient for cytopathological diagnosis. In two cases visual acuity detonated due to bleeding complications. Conclusion: Aspiration biopsy has been reported as a save technique in clinically undecisionable cases. However, in contrary to the recommendations of other authors, in our opinion, biopsy should be used for selected cases only, because of the severe risk of vitreous and subretinal bleeding.