Current Treatment of Choroidal Melanoma
Current Treatment of Choroidal Melanoma
Local resection of a choroidal melanoma should be considered as a treatment option when the patient is younger than 65 years of age, the tumor has a nasal location with a thickness greater than 8 mm (outside the limit for Ru-106 brachytherapy) and a diameter less than 15 mm, the distance from the foveola is more than 4 mm and the distance from the optic disc is more than 3 mm. Most secondary exorections are undertaken as a treatment for the toxic tumor syndrome, which develops when an irradiated intraocular tumor becomes ischemic and exudative as a result of intratumoral, radiation-induced vasculopathy. Macular edema and exudates, serous retinal detachment, uveitis, rubeosis iridis and neovascular glaucoma may be seen as a result of this condition. The procedure can be performed either through a scleral flap (exoresection) or through vitrectomy and using a vitreous cutter to remove the tumor from within in a piecemeal fashion (endoresection). Adjunctive radiotherapy is usually recommended following these procedures. Damato et al. evaluated postoperative vision in 163 patients with choroidal melanoma treated with local resection. In total, 88% of eyes were salvaged and 58% of these retained 6/60 or better vision. Retinal detachment and clinically evident residual or recurrent tumor were major complications that were reported. Others include expulsive hemorrhage, choroidal tears and complications related to hypotensive anesthesia. Another study that aimed to report local tumor control after trans-scleral local resection of uveal melanoma and to identify risk factors for clinical residual tumor suggested that tumor extension to within 1 disc diameter of the optic disc or fovea increases the risk of visible residual tumor after trans-scleral resection. In a retrospective study of 87 patients, Puusaari et al. compared the visual outcome and ocular complications of trans-scleral resection with I-125 plaque radiotherapy for large choroidal melanomas. Two major complications of brachytherapy, neovascular glaucoma and optic neuropathy, were low, whereas cataract, maculopathy, persistent retinal detachment and vitreous hemorrhage were common after trans-scleral resection. The 2-year incidence of losing 20/400 vision was 60% for trans-scleral resection and 75% for plaque radiotherapy.
Local Resection
Local resection of a choroidal melanoma should be considered as a treatment option when the patient is younger than 65 years of age, the tumor has a nasal location with a thickness greater than 8 mm (outside the limit for Ru-106 brachytherapy) and a diameter less than 15 mm, the distance from the foveola is more than 4 mm and the distance from the optic disc is more than 3 mm. Most secondary exorections are undertaken as a treatment for the toxic tumor syndrome, which develops when an irradiated intraocular tumor becomes ischemic and exudative as a result of intratumoral, radiation-induced vasculopathy. Macular edema and exudates, serous retinal detachment, uveitis, rubeosis iridis and neovascular glaucoma may be seen as a result of this condition. The procedure can be performed either through a scleral flap (exoresection) or through vitrectomy and using a vitreous cutter to remove the tumor from within in a piecemeal fashion (endoresection). Adjunctive radiotherapy is usually recommended following these procedures. Damato et al. evaluated postoperative vision in 163 patients with choroidal melanoma treated with local resection. In total, 88% of eyes were salvaged and 58% of these retained 6/60 or better vision. Retinal detachment and clinically evident residual or recurrent tumor were major complications that were reported. Others include expulsive hemorrhage, choroidal tears and complications related to hypotensive anesthesia. Another study that aimed to report local tumor control after trans-scleral local resection of uveal melanoma and to identify risk factors for clinical residual tumor suggested that tumor extension to within 1 disc diameter of the optic disc or fovea increases the risk of visible residual tumor after trans-scleral resection. In a retrospective study of 87 patients, Puusaari et al. compared the visual outcome and ocular complications of trans-scleral resection with I-125 plaque radiotherapy for large choroidal melanomas. Two major complications of brachytherapy, neovascular glaucoma and optic neuropathy, were low, whereas cataract, maculopathy, persistent retinal detachment and vitreous hemorrhage were common after trans-scleral resection. The 2-year incidence of losing 20/400 vision was 60% for trans-scleral resection and 75% for plaque radiotherapy.
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