The role of choroidal and retinal biopsies in the diagnosis and management of atypical presentations of uveitis.

PURPOSE Choroidal and retinal biopsies are often the investigation of last resort in evaluating patients with uveitis, because of the possible morbidity of the procedure. The most common indication is atypical uveitis, in which a diagnosis of malignancy or infection may be suspected. Here, we describe our experience at the Casey Eye Institute. METHODS This was a retrospective case series from January 2000 through October 2004. Cases labeled as "retinal or choroidal biopsy" were drawn from the pathology database at the Casey Eye Institute, and the pathology and clinic charts were reviewed. In all cases, the retinal and choroidal biopsies were obtained via an internal approach with a three-port pars plana vitrectomy. RESULTS Eight cases of atypical uveitis were found for which choroidal biopsies were performed. Five patients had had previous vitrectomies, in which examination of the vitreal sample had been inconclusive. Five patients had a definitive diagnosis after the biopsy and a good response to tailored therapy. In one case, diagnosis was made after biopsy, but clinical improvement was minimal despite appropriate treatment. One case had an inconclusive biopsy that enabled the exclusion of malignancy and infection with good response to immune suppression. In another case, choroidal biopsy was inconclusive and the eventual diagnosis was made only after enucleation. CONCLUSION Retinal and choroidal biopsies can be extremely useful in the diagnosis and further management of atypical, aggressive presentations of uveitis. In this small series, risk of complications was low. However, in patients with an inconclusive biopsy, an additional biopsy or enucleation should be considered in cases that progress or behave atypically on treatment based on the initial biopsy findings.