Endoscopic Ophthalmic Biopsy in Ocular Tumors: Case Report
Purpose
Describe the value of the ophthalmic endoscopy in patients with ocular tumor in where the visualization is limited by ocular media opacification.
Methods
Observational, clinical and surgical intervention study. 35 years old patient, with pain in left eye. Ophthalmoscopy: VA OS: LP. IOP OS: 32mmHg. Left eye shown: hyperemic conjunctiva, cornea edema, shallow anterior chamber, iris bombe, cataract, posterior pole was not evaluated due to media opacities. Ultrasound reported an occupying lesion, dome shape between M V - M VII about 4.34 mm , irregular structure and a reflectivity of 65%, without vascularization signs. UBM reported a small lesion that occupies the ciliary body from M V to M VII, in periphery choroids M VI. The plan proposed was a vitreoretinal endoscope for a biopsy.
Results
Endoscopy disclosed a retinal angiomatosis, and the diagnosis of melanoma was ruled out. Surgical procedure was modified as follows: cataract extraction with vitrectomy, perilesional photocoagulation and scleral criotherapy with an air-fluid exchange, Triamcinolone and Bevacizumab intravitreal injection plus silicon oil. In the Post-op the left eye showed an uncorrected visual acuity 20/20000, an IOP of 16 mmHg, anterior segment clear cornea, anterior chamber with silicon oil, iris with a periferic iridectomy M VII, under pharmacologic midriasis and aphakic. Posterior pole had an attached retina with perimacular and intraretinal hemorrhage, with clear silicon oil and triamcinolone.
Conclusion
Ophthalmic endoscopy has proved to be a useful technique to enhance and extend surgical control, especially in the retroirideal/ciliary body area, when standard microscopic imaging is limited by ocular media opacification.