Management of exudative retinal detachment in choroidal melanoma

Abstract

Exudative retinal detachment is the most common source of visual loss associated with malignant melanoma of the uveal tract. Management has historically been conservative, leading to irreversible visual loss from photoreceptor damage during the several months needed for post-radiation resolution. The purpose of this paper is to describe timely vitreoretinal surgical intervention for exudative retinal detachments associated with choroidal melanomas. This was an interventional case series including six consecutive patients with malignant melanoma who experienced VA reduction secondary to associated exudative retinal detachment. Patients underwent complete ophthalmic evaluation and B-scan ultrasound. Treatment included proton-beam radiation or brachytherapy, prognostic transretinal tumour biopsy with 25-gauge vitrector and surgical treatment of exudative retinal detachment, including vitrectomy and drainage of subretinal fluid at the time of irradiation. Successful management of exudative retinal detachments associated with choroidal melanomas was observed in all cases, with significant restoration of vision. Steady regression of tumour thickness was noted clinically and ultrasonographically, without extrascleral extension or metastasis, and with no recurrence of exudative retinal detachment found over follow up. In the present study, the investigators have showed effective surgical treatment of exudative retinal detachment associated with malignant melanoma. These patients had significant restoration of vision, confirming that timely intervention of exudative retinal detachment associated with malignant melanoma can reverse visual loss in these patients. These findings are in contrast to previous reports of irreversible visual loss after exudative retinal detachments, and suggest that photoreceptor atrophy might play a role in visual loss associated with chronic exudative retinal detachments.

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

“…To our knowledge, there is only one study by Gibran and Kapoor [15],which describes a similar treatment in 6 patients after brachytherapy (n = 5) and proton beam therapy (n = 1). It was successfully performed in all 6 patients, except 1 case of retinal redetachment (17%).…”

“…Drawing a comparison with the present study is difficult because of different tumor characteristics. Gibran and Kapoor [15] reported only 1 patient with a large tumor (height of 11.2 mm, basis of 16.5 mm) who received proton therapy. Our study represents mainly patients with large tumors with an equal success rate for retinal reattachment.…”

“…Gibran and Kapoor [15] proved in vivo that visual outcome can be restored by a contemporary reattachment. Thus, it seems reasonable to reattach the retina within a short period of time to maximize the visual-saving potential of this approach.…”

“…Resolution can be accelerated with the application of systemic or intravitreal steroids [16]. Gibran and Kapoor [15] proved in vivo that visual outcome can be restored by a contemporary reattachment. They performed a pars plana vitrectomy with endodrainage and silicone oil tamponade at the time of radiation therapy.…”

“…Spontaneous regression of the exudation may appear within up to 1 year [14,15]. Resolution can be accelerated with the application of systemic or intravitreal steroids [16].…”