Finger iridectomy technique (FIT): anterior segment uveal melanoma biopsy

The Finger iridectomy technique (FIT) utilizes the capabilities of small-gauge, machine-controlled, aspiration-cutter technology within visco-elastic stabilized and optimized anterior segment. A small diameter inked blade was used to create a beveled, self-sealing corneal incision. Visco-elastic was introduced to fill and manipulate the iris away from the target tissue. Then, the tubular, blunt-tipped, 27-gauge device with its single side port is placed onto the tumor where tumor parts are aspirated into and sliced by its internal guillotine blade. The liberated cells and microchunks collect within the aspiration-cutter shaft and effluent tubing assisted by machine-assisted, and surgeon-modulated aspiration. After the removal of the aspiration cutter from the eye, a 3 mL syringe was attached to the blue connector of the effluent tubing. Then, the tip of the aspiration cutter was placed in a small cup of balanced salt solution used to wash through and thus move the specimen into the syringe. Two aspiration passes were required. The visco-elastic was removed to prevent the post-operative increase in eye pressure. This technique was found to provide both cells for cytology and tissue for histology and immuno-histochemical analysis. In addition, the use of visco-elastic and the ability to both aspirate and cut allows for evacuation of secondary hemorrhage. Compared to manually controlled aspiration and sharp-tipped needles used for fine-needle aspiration biopsy (FNAB), FIT's aspiration-cutter-assisted biopsy herein described has provided enhanced tissue yield, minimal complications, and no vision loss. This video provides details on the surgical technique, to facilitate its adoption, and integration into clinical practice.