ABSTRACT

Purpose:

To report the outcomes of surgical endoresection with adjuvant radiotherapy as the primary treatment for large choroidal melanoma.

Materials & Methods:

Retrospective review of patients treated with 23g Pars plana vitrectomy, surgical endoresection, silicone oil tamponade, and adjuvant Ruthenium106-plaque radiotherapy. Patients a with a minimum 6-month follow-up were included into the analysis.

Results:

Between May 2014 and June 2017, fourteen patients fulfilled the inclusion criteria. There were 11 males and 3 females between 33 and 76 years of age (mean, 55 years). The greatest linear tumour diameter was between 9.2 and 14.4mm (mean, 11.9mm) with a thickness between 6.35 and 12.7mm (mean, 8.3mm). Baseline visual acuity was between logMAR -0.2 and 1.0 (mean, 0.6). The follow-up period ranged between 6 and 39 months (mean, 19 months). Histopathological examination confirmed the diagnosis of a choroidal melanoma in all patients with 4/14 tumours with monosomy 3 and 10/14 disomy 3. None of the patients showed clinical signs of a local tumour recurrence; one patient developed metastatic disease during the follow-up period. A retinal detachment requiring further surgery could be observed in 2/14 patients. The silicone oil tamponade was removed in 13/14 patients during the study period. This was combined with an epiretinal membrane peel in 7 patients. In 13/14 eyes, a phaco/IOL procedure was performed either during the initial procedure or during the follow-up period. A macular oedema developed in 9/14 patients. Final visual acuity was between logMAR 0.2 and 1.8 (mean, 0.9).

Conclusion:

Surgical endoresection with adjuvant radiotherapy is a successful treatment method for large choroidal melanoma with excellent tumour control and eye preservation rates. This is in comparison to endoresections without adjuvant plaques which have higher recurrence rates. Safely avoiding enucleation in an eye with good vision is possible with this technique. The major complications observed in this series were a relatively high rate of cystoid macula oedema and epiretinal membrane formation.


CONTACT DETAILS

 

Heinrich HEIMANN, Lara SANDRI*, Rumana HUSSAIN, Carl GROENEWALD
St Pauls – Royal Liverpool Hospital
Liverpool
United Kingdom
Email : Lsandri@supernet.co.za
Cell Phone: +4427824681365
Work Phone: +4427118841440