Small incision guarded hydroaspiration of iris lesions

Abstract

Small incision guarded hydroaspiration is a minimally invasive surgical technique for resection of select small iris lesions. Use of multiple small corneal incisions avoids morbidity associated with a single large corneoscleral incision, and use of guarded aspiration may eliminate the risk of wound contamination by the malignant tumour.

Cysts and tumours of the iris: Diagnostic tools and key management considerations—A review

“…45 More recently, Singh reported on a series of 22 small iris lesions (largest basal diameter <5.0 mm and thickness <2.5 mm) that were resected with a minimally invasive technique. 69 This was composed of multiple small corneal incisions that allowed Ultrasound biomicroscopy (D) of lesion demonstrates significant stromal thickening with high reflectivity noting a small region of acoustically empty space between the stroma and anterior border layer. On histology (E), the spaces seen on ultrasound are histologically confirmed as cystic inclusion of iris pigment epithelium within a mixed epithelioid and spindle cell melanoma.…”

“…for internal iris resection with 23-gauge vitrectomy scissors, followed by guarded tumour aspiration through clear plastic tubing. 69 McGhee et al contemporaneously, but independently, described the minimal iris touch excision (MITE) technique, which similarly allows resection of tumours via small clear corneal incisions. 26,70 These minimally invasive techniques reduce the risk of wound leak, hypotony, astigmatism and tumour seeding whilst shortening the recovery time.…”

“…26,70 These minimally invasive techniques reduce the risk of wound leak, hypotony, astigmatism and tumour seeding whilst shortening the recovery time. 69,70 Subsequently, in 2022 the McGhee group reported on 51 cases of iris and ciliary body melanoma having successful initial iridectomy (29%) or irido-cyclectomy (8%) for tissue diagnosis and tumour debulking. 26 The main complications of biopsy are glare, hyphaema, cataract, infection, and elevated IOP.…”