Ihab Saad Mahmoud Othman, MD, FRCS (Glasg), Cairo, Egypt

Advantages:

Uveal melanoma resection offers a last resort in management of large and extra-large uveal tumors when enucleation remains the only option. Studies have shown no statistical difference in long-term survival between enucleation and surgical resection.

Methods:

Consecutive prospective case series presenting with iris, iridiociliary, irido-cilio-choroidal, cilio-choroidal or choroidal masses.

Results:

Forty-nine cases were identified between July 2000 and December 2008. Age varied from 13 years to 72 years.  Tumor was located in the iris in 6 cases, iris and ciliary body in 5 cases, ciliary body in 5 cases, ciliochoroidal in 18 cases. iridociliochoroidal in 4 cases, and choroid in 11 cases. Mean tumor diameter was 13.6 mm in diameter (range 4-21 mm) mean tumor thickness was 8 mm (range 6-12 mm). Surgery was associated with insertion of radioactive plaque brachytherapy in 19 cases, and laser diode thermotherapy was used postoperatively to tumor bed in 11 cases. Surgical complications included mild hemorrhage in 40 cases, persistent vitreous hemorrhage and or retinal detachment in 22 cases managed by vitrectomy. Tumor recurrence was noted in 15 cases with a mean time to recurrence of 47 months. Recurrence was statisctically significant in cases not managed with concomitant brachytherapy. Ocular salvage was achieved in 37/49 cases (75.5 %) of the cohort. Metastasis was noted in 14 cases (29.8 %) at 5 years and rose to affect 24 cases (51.1 %) at 10 years. Mean interval to metastases was 55 months (range 24-86 months)

Effectiveness / Safety:

Uveal lamellar tumor resection is a technically demanding technique associated with ocular salvage in big tumors in 75.5% of cases. Concomitant use of brachytherapy is associated with less rate of recurrence. Second intervention may be necessary in many cases with persistent vitreous hemorrhage or retinal detachment. Long-term follow up is essential to detect survival.

Take home message:

DO not give up on an eye with big uveal tumor.