TSR is an alternative to enucleation for the treatment of large uveal melanomas. Results should improve with better patient selection and more effective methods of adjuvant radiotherapy.

ABSTRACT

We present a biopsy-proven iris diffuse melanoma treated with palladium-103 plaque radiation therapy. Though the entire anterior segment was irradiated, there were no significant side-effects. Local tumor control was excellent during the first postoperative year.

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In the case of severely traumatized eyes with aniridia and aphakia, the implantation of a black ILD can have a positive effect on functional and anatomic stabilization.

Choroidal melanoma is the most common primary intraocular malignancy. Diagnosis is performed by clinical evaluation: eye cancer specialists currently use multiple diagnostic techniques, including ophthalmoscopy, fundus autofluorescence imaging (FAF), fluorescein angiography (FA), and indocyanine green angiography (ICG), as well as optical coherence tomography (OCT). Tumor biopsy has recently become popular due to the availability of diagnostic cytogenetic features, touted as biomarkers for metastasis. Standard treatments include observation (select small melanomas and indeterminate tumors), radiation therapy (plaque, proton beam), eye wall resection, and removal of the eye. Of these, ophthalmic plaque radiation therapy has become the most common and widely available conservative treatment. Successful initial treatment offers the best chance to prevent subsequent metastasis. Metastatic choroidal melanoma is typically diagnosed by combinations of physical examination, hematologic surveys, abdominal radiographic imaging (ultrasound, magnetic resonance imaging, computed tomography), and positron emission tomography–computed tomography (PET/CT). Most often initially found in the liver, metastatic choroidal melanoma carries an unfavorable prognosis for life. Herein, we report on currently available methods of diagnosis and treatment for choroidal melanoma.

The treatment of large uveal melanomas poses a therapeutic challenge, due to the expected treatment-related side-effects. After sole radiotherapy the majority of patients are faced with radiogenic complications secondary to the large amount of tumour necrosis. Alternative treatment modalities addressing this issue are transscleral resection in arterial hypotension in anteriorly located tumours and endoresection via pars plana vitrectomy in posteriorly located tumours. A surgical resection treatment was applied in 292 patients with large uveal melanomas. In 150 patients the tumour was treated by transscleral resection and postoperative adjuvant (106)ruthenium brachytherapy and 142 patients were treated by primary proton beam irradiation and secondary endoresection. The mean follow-up time was 3.8 and 2.5 years, respectively. Local tumour control was achieved in 76 % and 98 %, respectively. The 5-year metastatic rates were 28 % and 21 % and eye retention was achieved in 82 % and 97 %, respectively. Surgical resection of uveal melanomas with adjuvant radiotherapy is the treatment of choice in cases of large tumours, avoiding enucleation in the vast majority of cases in the long term, without increasing the incidence of tumour-related risks.