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.