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. 1998 Mar;82(3):213–218. doi: 10.1136/bjo.82.3.213

Endoresection of choroidal melanoma

B Damato 1, C Groenewald 1, J McGalliard 1, D Wong 1
PMCID: PMC1722501  PMID: 9602614

Abstract

AIMS—The results of 52 endoresections for choroidal melanoma are reported.
METHODS—The current technique involves vitrectomy, retinal incision over or peripheral to the tumour, haemostasis by raising intraocular pressure and by moderate hypotensive anaesthesia, choroidal incision around tumour, endoresection with vitrector, endodiathermy to bleeding points and residual tumour, fluid-air exchange to reattach retina, endolaser to achieve retinal adhesion around the coloboma and destroy residual tumour in the sclera, silicone oil injection with removal after 12 weeks, cryotherapy to the sclerotomies, and adjunctive ruthenium plaque radiotherapy in selected cases.
RESULTS—Patients receiving primary endoresection had a mean age of 53 years, a mean largest basal tumour diameter of 8.2 mm, and a mean tumour thickness of 3.9 mm. 40 tumours extended to within 2 disc diameters of the optic disc, with 17 involving disc. Follow up ranged from 40 days to 7 years (median 20 months). At the last visit, 90% of eyes were retained, with vision of 6/6-6/12 (two), 6/18-6/36 (three), 6/60 to counting fingers (18), hand movements (nine), and light perception (four). The main complications were retinal detachment in 16 and cataract in 25. Secondary endoresection (11) was performed after plaque radiotherapy (four), photocoagulation (four), trans-scleral local resection (two), and proton beam radiotherapy (one), with retention of the eye in nine cases. By the close of the study, no patients developed definite local tumour recurrence but one died of metastatic disease 41 months postoperatively.
CONCLUSION—Depending on tumour location, endoresection may conserve central vision or temporal field when radiotherapy would be expected to cause optic neuropathy. Longer follow up is necessary to establish the efficacy of tumour control.

 Keywords: uveal melanoma; choroidal melanoma; ocular neoplasms; vitrectomy; endoresection; photocoagulation

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Figure 1  .

Figure 1  

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Right fundus of a 37 year old female, (A) preoperatively, showing a superior choroidal melanoma having basal dimensions of 4.6 mm by 4.2 mm, with a thickness of 2.3 mm, and (B) 22 months postoperatively, when the vision was 6/9. Histology showed the melanoma to be of mixed cell type.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Foulds W. S., Damato B. E. Low-energy long-exposure laser therapy in the management of choroidal melanoma. Graefes Arch Clin Exp Ophthalmol. 1986;224(1):26–31. doi: 10.1007/BF02144128. [DOI] [PubMed] [Google Scholar]
  2. Gragoudas E. S., Egan K. M., Seddon J. M., Walsh S. M., Munzenrider J. E. Intraocular recurrence of uveal melanoma after proton beam irradiation. Ophthalmology. 1992 May;99(5):760–766. doi: 10.1016/s0161-6420(92)31900-1. [DOI] [PubMed] [Google Scholar]
  3. Lee K. J., Peyman G. A., Raichand S. Internal eye wall resection for posterior uveal melanoma. Jpn J Ophthalmol. 1993;37(3):287–292. [PubMed] [Google Scholar]
  4. Lommatzsch P. K., Lommatzsch R. Treatment of juxtapapillary melanomas. Br J Ophthalmol. 1991 Dec;75(12):715–717. doi: 10.1136/bjo.75.12.715. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Oosterhuis J. A., Journée-de Korver H. G., Kakebeeke-Kemme H. M., Bleeker J. C. Transpupillary thermotherapy in choroidal melanomas. Arch Ophthalmol. 1995 Mar;113(3):315–321. doi: 10.1001/archopht.1995.01100030071024. [DOI] [PubMed] [Google Scholar]
  6. Peyman G. A., Charles H. Internal eye wall resection in the management of uveal melanoma. Can J Ophthalmol. 1988 Aug;23(5):218–223. [PubMed] [Google Scholar]
  7. Peyman G. A., Nelson N. C., Jr, Paris C. L., Blinder K. J., Alturki W. A., Desai U. R. Internal choroidectomy of posterior uveal melanomas under a retinal flap. Int Ophthalmol. 1992 Nov;16(6):439–444. doi: 10.1007/BF00918434. [DOI] [PubMed] [Google Scholar]
  8. Quivey J. M., Augsburger J., Snelling L., Brady L. W. 125I plaque therapy for uveal melanoma. Analysis of the impact of time and dose factors on local control. Cancer. 1996 Jun 1;77(11):2356–2362. doi: 10.1002/(SICI)1097-0142(19960601)77:11<2356::AID-CNCR26>3.0.CO;2-V. [DOI] [PubMed] [Google Scholar]
  9. Seddon J. M., Gragoudas E. S., Egan K. M., Glynn R. J., Munzenrider J. E., Austin-Seymour M., Goitein M., Verhey L., Urie M., Koehler A. Uveal melanomas near the optic disc or fovea. Visual results after proton beam irradiation. Ophthalmology. 1987 Apr;94(4):354–361. doi: 10.1016/s0161-6420(87)33439-6. [DOI] [PubMed] [Google Scholar]
  10. Shields C. L., Shields J. A., DePotter P., Kheterpal S. Transpupillary thermotherapy in the management of choroidal melanoma. Ophthalmology. 1996 Oct;103(10):1642–1650. doi: 10.1016/s0161-6420(96)30451-x. [DOI] [PubMed] [Google Scholar]

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