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. 1998 Oct;82(10):1147–1153. doi: 10.1136/bjo.82.10.1147

Internal resection of posterior uveal melanomas

P Kertes 1, J Johnson 1, G Peyman 1
PMCID: PMC1722373  PMID: 9924302

Abstract

AIMS—To evaluate the safety and efficacy of internal resection in the treatment of malignant melanoma of the choroid.
METHODS—32 consecutive patients with histopathologically proved malignant choroidal melanomas were treated with internal resection. 29 of the 32 (90.6%) tumours were within 2 disc diameters of the optic nerve or fovea. The surgery was performed at two university centres by one of the authors. Follow up was between 1 and 85 months (mean 40.1 months).
RESULTS—Three patients developed distant metastases and died of malignant melanoma (metastatic and mortality rate 9.4%). In one case, distant metastases developed in association with an intraocular recurrence. There have been no other intraocular recurrences. The most common postoperative complication was vitreous haemorrhage, which occurred in 12 patients (37.5%); cataract occurred in eight eyes; and three patients developed retinal detachment postoperatively. Three of the operated eyes have been enucleated (9.4%); a total of four (12.5%) have lost light perception. 10 patients (31.2%) had visual acuities of 6/60 or better and 18 of 32 (56.3%) were between 6/120 and light perception.
CONCLUSION—These data suggest that the internal resection of posterior uveal melanomas is a reasonable globe saving management option. This treatment modality is particularly well suited to elevated tumours in close proximity to the optic nerve or fovea.

 Keywords: choroidal melanoma; internal resection; malignant melanoma; posterior uveal melanoma

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Figure 1  .

Figure 1  

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Schematic diagram illustrating the salient features of the surgical technique. (A) Endodiathermy is applied in an arcuate fashion to the retina peripheral to the tumour. (B) A retinotomy is created with intraocular scissors and dissected free of the tumour in an anterior to posterior direction. (C) Diathermy and argon laser endophotocoagulation are applied over the tumour surface and margins and, under hypotensive anaesthesia, all visible tumour is resected with the vitrector down to bare sclera. (D) The retinal flap is reposited and an air-fluid exchange performed. Laser is applied to the edges of the retinotomy and the eye is filled with silicone oil (5000 centistokes).

Figure 2  .

Figure 2  

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Arteriovenous phase fluorescein angiogram of the patient's left eye in 1987 demonstrating hyperfluorescence of a small choroidal tumour.

Figure 3  .

Figure 3  

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Arteriovenous phase fluorescein angiogram of the patient's left eye at presentation to us in August 1995, demonstrating early hyperfluorescence of a large choroidal melanoma.

Figure 4  .

Figure 4  

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Fundus photograph of the patient's asymptomatic right eye at presentation to us in August 1995, demonstrating an amelanotic flat choroidal lesion temporal to the macula.

Figure 5  .

Figure 5  

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(A) Histological section of the material collected and spun down from the vitrectomy cassette demonstrating clumps of epithelioid melanoma cells together with bits of normal retina (arrow) and choroid (haematoxylin and eosin, original magnification, ×100). (B) Higher power view of a clump of tumour cells consisting almost exclusively of epithelioid melanoma cells (haematoxylin and eosin, original magnification ×400).

Figure 6  .

Figure 6  

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Fundus photograph of the patient's left eye 6 months postoperatively shows the intact retinal vessels running over the scleral bed from which the tumour has been resected.

Selected References

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