In-clinic vitreous biopsy peel pack technique

Charles DeBoer; Cindy Zhao; Prithvi Mruthyunjaya; Vinit B Mahajan; Karen M Wai; Steven R Sanislo

doi:10.1186/s40942-025-00639-8

In-clinic vitreous biopsy peel pack technique

Int J Retina Vitreous. 2025 Feb 10;11(1):15. doi: 10.1186/s40942-025-00639-8.

Authors

Charles DeBoer^{1

2}, Cindy Zhao³, Prithvi Mruthyunjaya³, Vinit B Mahajan^{4

3

5}, Karen M Wai³, Steven R Sanislo^{4

3}

Affiliations

¹ Molecular Surgery Laboratory, Stanford University, 2452 Watson Court, Palo Alto, CA, 94304, USA. cdeboer@stanford.edu.
² Department of Ophthalmology, Byers Eye Institute, Stanford University, 2452 Watson Court, Palo Alto, CA, 94304, USA. cdeboer@stanford.edu.
³ Department of Ophthalmology, Byers Eye Institute, Stanford University, 2452 Watson Court, Palo Alto, CA, 94304, USA.
⁴ Molecular Surgery Laboratory, Stanford University, 2452 Watson Court, Palo Alto, CA, 94304, USA.
⁵ Veterans Affairs Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, USA.

Abstract

Background: Vitreous biopsy is a common technique used to guide management of acute endophthalmitis and help differentiate between infectious and inflammatory conditions. Currently, in-clinic vitreous biopsy is performed with a 25-gauge needle, without the ability to cut vitreous, potentially leading to reduced diagnostic yield. Recent work demonstrated the ability to perform vitreous biopsy with an off-the-shelf vitreous cutter. However, this was limited by complexity of assembly. Here, a technique using a single peel pack vitrectomy cutter is demonstrated for in-clinic vitreous biopsy.

Methods: A 25-gauge vitreous cutter is opened from a peel pack. The drive line is identified, cut to length, and attached to a 10 mL syringe. A 1 mL syringe is attached to the aspiration line. After a trocar is used to place a cannula in the pars plana, the vitreous cutter is introduced into the eye. Cutting is performed by an assistant actuating the 10 mL syringe while the surgeon aspirates from the 1 mL syringe. After sample is collected, antimicrobials are injected if required and the cannula is removed.

Results: A peel pack technique simplifies assembly for an in-clinic vitreous biopsy using a manually actuated cutter.

Conclusion: We present a novel, improved, and simplified technique for vitreous tap using a vitreous cutter provided in a single peel pack, actuated by a single syringe with minimal assembly prior to use. This technique may be more accessible for clinicians than prior techniques and does not require a surgical console.

Keywords: Endophthalmitis; Office-based vitrectomy, Uveitis, Masquerade syndrome; Vitrectomy; Vitreous biopsy.

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