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Small incision guarded hydroaspiration of iris lesions
  1. Arun D Singh
  1. Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Arun D Singh, Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; singha{at}


Aim To describe the technique and results of a minimally invasive surgical technique for resection of small iris lesions.

Methods Consecutive case series of 22 patients with localised, small iris lesions that were resected using the described surgical technique that composed of multiple, small corneal incisions created to allow for internal iris resection with 23-gauge horizontal vitrectomy scissors, followed by guarded tumour aspiration through a clear plastic tubing (diameter 3.5 mm) primed with viscoelastic agent.

Results The mean largest basal diameter was 3.0 mm (range 1.5–5.0 mm; median 3.0 mm) and mean thickness was 1.3 mm (range 0.5–2.5 mm; median 1.0 mm). Use of multiple (2–4) small corneal incisions (range 2.0–3.0 mm; mean 2.8 mm) allowed reduced postoperative morbidity (significant hyphema (0%), hypotony (0%), wound leak (0%), >2 line change in best corrected visual acuity at postoperative 1 week (4.5%) and mean corneal astigmatism of 1.0 D (range 0.14–2.99 D; median 0.8 D) at postoperative 4–12 weeks. The tumour could be resected with clear surgical margins in all neoplastic cases (benign (2), borderline (1) and malignant (16)). Local recurrence or metastases were not observed in any melanoma case over a mean follow-up of 33.0 months (range 1.0–90.0 months; median 33.5 months).

Conclusions 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.

  • Iris
  • Neoplasia
  • Pupil

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  • Contributors ADS conceptualised, wrote and edited the manuscript.

  • Funding This study is supported in part by the Cole Eye Institute, Research to Prevent Blindness unrestricted grant.

  • Competing interests ADS reports personal fees from Castle Biosciences, Aura Biosciences, Iconic Therapeutics and Isoaid Therapeutics, outside the submitted work. In addition, ADS has a patent risk calculator for vision loss following brachytherapy pending.

  • Ethics approval IRB Cleveland Clinic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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