Primary transpupillary thermotherapy of choroidal melanocytic lesions

To evaluate the role of primary transpupillary thermotherapy [TTT] in the treatment of choroidal melanocytic lesions. Retrospective chart review of 24 patients [24 eyes] with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization. The mean initial tumor basal diameter was 6.6 [3.0-10.0] mm and the mean initial tumor thickness was 3.0 [1.0-5.0] mm. The mean number of TTT sessions was 2.5 [1-6]. The mean decrease in tumor thickness was 1.2 mm [from 3.0 to 1.8 mm] at a mean follow-up of 22.7 [range 3-90] months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients [20.8%]], focal cataract [5 patients [20.8%]], iris atrophy [4 patients [16.6%]] and posterior synechia [4 patients [16.6%]]. There was no significant difference in the complication rate with respect to tumor thickness >3 mm versus tumor thickness <3 mm and juxtapapillary versus nonjuxtapapillary location [Fisher's exact test, P>0.05]. Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes [8.3%] were enucleated because of neovascular glaucoma and one eye [4.1%] was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients [87.5%]. One patient [4.1%] with extraocular tumor recurrence developed liver metastasis and expired. Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved

Photodynamic therapy of symptomatic choroidal nevi

To evaluate the role of photodynamic therapy [PDT] for patients with symptomatic choroidal nevi involving the fovea or located near the fovea with subretinal fluid extending to the fovea. Retrospective review of five patients who underwent PDT for choroidal nevi at two separate centers in Ankara and Barcelona. The mean initial logMAR visual acuity was 0.5 [range: 0 to 1.5]. The mean largest tumor base diameter was 3.2 mm [range: 2.1-4.5 mm] and the mean tumor thickness was 1.1 mm [range: 0.7-1.6 mm]. The mean number of PDT sessions was 1.6 [range:1-3]. The mean final tumor thickness was 1.0 mm [range: 0-1.6 mm] at a mean follow-up of 19 months [range: 12-32 months]. The mean final logMAR visual acuity was 0.4 [range: 0-1.5]. Subfoveal fluid disappeared or decreased significantly in 4 of 5 eyes [80%] after PDT. PDT led to resolution of subretinal fluid with preservation of visual acuity in many symptomatic choroidal nevi in this study. Careful case selection is important as PDT of indeterminate pigmented tumors may delay the diagnosis and treatment of an early choroidal melanoma and thereby increase the risk for metastasis

Exoresection and endoresection for uveal melanoma

Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. There are two surgical resection techniques: Transscleral resection or "Exoresection" via a partial lamellar sclerouvectomy and "Endoresection" via a pars plana vitrectomy. While exoresection is more applicable to anteriorly located tumors with ciliary body and/or iris involvement, endoresection is more suitable for posteriorly located tumor without ciliary body involvement. Both approaches are suitable for large tumors with >8 mm in thickness. In general, eyes containing these large tumors have a very dismal prognosis regarding long-term visual function, eye retention, and irradiation-induced side effects. By removing the tumor burden from the eye, histopathologic and cytogenetic information of the tumor is available and complications associated with the so-called toxic tumor syndrome are avoided. However, both types of surgical resection are challenging surgical procedures, bearing the risk of early and late postoperative complications