Human chorioretinal biopsy under controlled systemic hypotensive anaesthesia.

Abstract

SUMMARY This paper describes a simplified technique for biopsy of the retina and choroid which had been used in 5 human volunteers. The biopsy was carried out in 4 immediately before enucleation of an eye for malignant melanoma and in 1 patient who was undergoing trabeculectomy for painful glaucoma associated with retinitis pigmentosa. A combination of intravenous mannitol and transient controlled systemic hypotension, induced under general anaesthesia with intravenous sodium nitroprusside, was used in 3 cases and resulted in no vitreous loss and minimal bleeding. In the 2 cases in which hypotension was not used bleeding was a definite problem, but no vitreous loss was experienced.Understanding of many types of chorioretinal pathology has long been retarded by the lack of a practical biopsy technique. Previous workers have described a full-thickness eye wall method for biopsy of the posterior segment in rabbits, monkeys, and 1 human.' A transvitreal approach to retinal biopsy has also been reported in animals.4 These methods have not been widely adopted because of the complexity of the procedure and of the universal vitreous loss reported. A simplified trans-scleral approach to chorioretinal biopsy in dogs using hypotensive anaesthesia resulted in minimal or no vitreous loss,5 so that we were encouraged to apply the procedure to 5 human volunteers. Patients and methods CASE 1A 35-year-old male presented to the neurology outpatients with a 6-week history of blurred vision in the left eye. Vision was 6/6 right, counting fingers left, and a superior field defect was noted in the left eye. On referral to the ophthalmology department a large serous detachment of the inferior retina in the left eye was noted as well as an underlying pigmented mass that had the clinical characteristics of a large melanoma of the choroid. Fluorescein angiography, 32P isotope testing, and ultrasonography all suggested a melanoma of the Correspondence to Professor 1. J. Constable, University

Vitreous, Retinal, and Choroidal Biopsy

“…49,50,60 Cyanoacrylate tissue glue can be used to stabilize the choroidal specimen before its removal from the eye. In this situation, hemostasis may be improved by systemic hypotensive anesthesia.…”

Biomarker potential of vitreous microRNA in retinal disease: a meta-analysis

“…As a result, for most retinal diseases which do not necessitate a diagnostic biopsy, our understanding of the molecular pathogenesis is limited. Animal models, such as rodents, rabbits, dogs, and non-human primates, have undergone retinal biopsies for the study of retinal disease (7–9). However, the utility of animal models is limited by sample size for larger animals and differences in physiology and anatomy between smaller animals and humans.…”

Culture of retinal pigment epithelium from chorio‐retinal biopsies

“…The biopsy technique for sampling chorio-retinal tissue has opened new ways to monitor retinal disease (Peyman et al 1975; Griffin et al 1975; Constable et al 1980). Although the amount of retinal pigment epithelium in such a specimen is adequate for a morphological analysis, it is not sufficient for a more detailed study of biological and biochemical parameters.…”