Combined enucleation and orbitotomy for choroidal melanoma with orbital extension

Modified Enucleation for Choroidal Melanoma with Large Extrascleral Extension

“…Uveal melanoma with large anterior or well definite extrascleral extension may be treated with standard enucleation or modified enucleation with partial tenonectomy at the site of extraocular extension (Rini et al, 1987;Shilds et al, 1992). Uveal melanoma with massive perioptic/posterior extrascleral extension may not be safely treated with standard enucleation, without the risk of transecting the orbital component (Singh et al, 2006). Although orbital exenteration was used for uveal melanoma with large perioptic/posterior extrascleral extension over the recent years, this treatment appears to be palliative rather then curative, and there is no evidence of increasing survival in these patients (Kersten et (Kersten et al, 1985).…”

“…The absence of any local tumor recurrence during long-term follow-up confirms that enlarged enucleation via lateral orbitotomy allows a complete tumor excision in patients affected by massive, encapsulated perioptic/posterior extrascleral extension. Using this technique, uveal melanoma extrascleral extension can be directly visualized during enucleation procedure and, under direct visualization of the intraconal space, a long optic nerve stump can be obtained (Singh et al, 2006). Moreover, this approach allows the placement of an orbital implant in the same surgical procedure, with excellent cosmetic outcome (De Potter et al, 1992).…”

“…Combining standard enucleation procedure with lateral orbitotomy allows performing in essence what can be described as a muscle sparing posterior orbital exenteration. The use of modified enucleation via lateral orbitotomy, in selected patients, avoids orbital tumor transecting and its consequent increased mortality, also avoiding orbital exenteration and its consequent local morbidity (Singh et al, 2006;De Potter et al, 1992).…”

Conjunctival and uveal melanoma: Survival and risk factors following orbital exenteration

“…7 Several factors such as tumour size, presence or absence of metastases, visual acuity of the affected and contralateral eye, general health of the patient and location contribute to the choice of the best treatment option. 8 These include brachytherapy, charged-particle radiation therapy, photocoagulation, transpupillary thermal therapy, photodynamic therapy, transretinal or transscleral resection and enucleation. 9 Common to both tumours, however, is that orbital exenteration remains the last resort.…”