Partial lamellar sclerouvectomy surgery for anteriorly located uveal tumour resection: a 20-year experience

Mirzayev, Ibadulla; Gündüz, Ahmet Kaan; Heper, Aylin Okçu

doi:10.1038/s41433-021-01545-7

Cited by 9 publications

(9 citation statements)

References 28 publications

(55 reference statements)

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“…Partial lamellar sclerouvectomy was invented over 30 years ago [ 18 , 19 ] in order to remove melanomas that involved the ciliary body or the choroid, while leaving the outer portion of the sclera and the overlying sensory retina intact. Additionally, there are a few circumstances in which surgery should be the first option [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

Relimpio-López

Garrido-Hermosilla

Espejo

et al. 2022

JCM

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Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

Relimpio-López

Garrido-Hermosilla

Espejo

et al. 2022

JCM

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“…In our selected cases, PTSU combined with MVRE was used as a primary globe-preserving treatment to prevent irradiation or enucleation and to conserve useful visual acuity. Some authors have reported the experience and outcome with local resection of intraocular tumors in the Caucasian population (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). However, most of the reported series (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) have not subcategorized patients with intraocular tumors based on the pediatric and adult age groups; particularly, the effectiveness of local resection in Asian population is still unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Resection is classified based on the tissue involved as iridectomy, iridocyclectomy, iridogoniocycletomy, iridocyclochoroidectomy, iridogoniocyclochoroidectomy, partial lamellar sclerouvectomy (PLSU) (1)(2)(3)(4)(5), or local resection via 23-to 25-gauge micro-invasive vitrectomy for the excision of intraocular tumors, which we have termed as partial transscleral sclerouvectomy (PTSU) combined with microinvasive vitrectomy and reconstruction of the eyeball (MVRE). Previous studies have termed surgical excision "en bloc" or "eye wall" resection (6)(7)(8). There are few previous studies that have evaluated the success of surgical resection for UMs in Caucasian adults (2)(3)(4)(5)(6)(7)(8)(9)(10)(11), while the published literature is lacking the outcomes of local resection of intraocular tumors in the Asian population.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have termed surgical excision "en bloc" or "eye wall" resection (6)(7)(8). There are few previous studies that have evaluated the success of surgical resection for UMs in Caucasian adults (2)(3)(4)(5)(6)(7)(8)(9)(10)(11), while the published literature is lacking the outcomes of local resection of intraocular tumors in the Asian population. Herein, to further explore the potential benefits of this surgical procedure, we reported an analysis of the outcomes of PTSU combined with MVRE for intraocular tumors in the pediatric and adult groups in the Asian population.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Resection of Intraocular Tumors (Partial Transscleral Sclerouvectomy Combined With Mircoinvasive Vitrectomy and Reconstruction of the Eyeball) in Asian Patients: Twenty-Five Years Results

Zhou

Wang

et al. 2022

Front. Oncol.

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ObjectiveTo describe the outcome of intraocular tumor resection by partial transscleral sclerouvectomy (PTSU) combined with micro-invasive vitrectomy and reconstruction of the eyeball (MVRE) in Asian patients.Design, Methods and ParticipantsThis retrospective, interventional cohort study included 366 patients who underwent PTSU combined with MVRE for intraocular tumors both in adult and pediatric age groups. The medical records of these patients were reviewed for clinical, operative, and histopathological features.Main Outcome MeasuresGlobe salvage, best corrected visual acuity (BCVA), surgical side effects, tumor control, and tumor-related metastasis and death.ResultsThe mean follow-up duration was 87 months (median, 66; range, 1-303 months). Among the 366 patients, the mean age was 8.5 years (median, 7; range, 1-19 years) in the 37 pediatric patients, and was 43 years (median, 42; range, 20-51) in 329 adult patients. The tumor mainly involved the ciliary body (n=136; 37.2%) and choroid (n=86; 23.5%). The common pathologic diagnosis of the 366 patients was as follows. In the pediatric age group, histopathologic examination revealed positive tumor margins in 37 patients mainly including ciliary body medulloepithelioma (8/37), ciliary body melanocytoma (13/37) and uveal melanoma (5/37). In the adult group, the pathological diagnosis mainly included melanoma (195/329), RPE adenoma (21/329), amelanotic melanoma (13/329), ciliary body adenoma of nonpigmented epithelium (19/329), schwannoma/neurilemmoma (11/329), melanocytoma (24/329), and leiomyoma (9/329). The globe salvage rate was 81.1% in the pediatric age groups (<20 years), and 93.6% in the adult group (≥20 years), respectively. Of the 338 salvaged eyes, final BCVA was 20/20 to 20/40 in 16 (4.7%), 20/40 to 20/80 in 58 (17.2%), 20/80 to 20/200 in 160 (47.3%), and ≤ 20/200 in 104 (30.8%). Early side effects included corneal edema in 28 (7.7%) patients, hyphema in 46 (12.6%), and vitreous hemorrhage in 76 (21%) patients. Postoperative side effects included proliferative vitreoretinopathy (PVR) in 67 (18.3%), late cataract in 42 (11.5%), and glaucoma in 18 (5%) patients. Local tumor recurrence was detected in 20 patients (5.5%) at a mean interval of 23.6 months, including melanoma (n=19) and medulloepithelioma (n=1). Enucleation was necessary in 28 (7.7%) cases owing to recurrence in 15 (53.6%), eye prophylaxis with high-grade malignancy in 5 (17.8%), and blind painful eye in 8 (28.6%) cases. Kaplan-Meier estimated for 5, 10-year metastasis rate and metastasis-related death rate (95%CI) in 213 UM patients were 3.2% (1.4%-7.0%), 6.9% (3.8%-12.3%); and 3.5% (1.6%-7.6%), 7.6% (4.2%-13.5%), respectively.ConclusionsAs a surgically challenging procedure, PTSU combined with MVRE offers several theoretical advantages over enucleation and radiotherapy. It can achieve control of most intraocular tumors, preserve useful vision, and maintain a cosmetically normal eye.

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“…Conservative surgery with local excision such as partial lamellar sclerouvectomy was not possible given the advanced mass size [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Underlying Ciliary Body Uveal Melanoma in a Patient with Chronic Lymphocytic Leukemia Presenting for Hyphema

et al. 2022

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(1) Background: Ciliary body uveal melanoma is a rare subtype of uveal melanoma which comprises 3–5% of melanomas, an immunogenic cancer, and can present multifaceted initial clinical manifestations, masquerading as various ocular pathologies. Chronic lymphocytic leukemia (CLL) presents immunodeficiency and risk for the development of a secondary malignancy, with Bruton’s tyrosine kinase inhibitor treatment having a mutagenic effect and a secondary anti-platelet aggregation effect. We present the case of a 65-year-old patient undergoing treatment for CLL with ibrutinib who presented with recurrent hyphema that masked an underlying, inferiorly situated, ciliary body uveal melanoma; (2) Methods: Retrospective case review; (3) Results: An ophthalmological examination together with imaging via mode B ultrasound and contrast-enhanced magnetic resonance imaging resulted in the clinical and imagistic diagnosis of a ciliary body uveal melanoma. A pathological examination of the enucleated eye confirmed the diagnosis. Postoperative tumoral reoccurrence was not detected for 1½ years, however, CLL immunosuppression worsened with admission for severe COVID-19 disease. (4) Conclusions: CLL patient screening for melanoma should also include detailed ophthalmological examinations, which could also include ultrasound ophthalmological imaging. The avoidance of uveal melanoma metastatic disease is paramount for patient survival. CLL manifests additional profound immunosuppression.

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Partial lamellar sclerouvectomy surgery for anteriorly located uveal tumour resection: a 20-year experience

Cited by 9 publications

References 28 publications

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

Clinical Outcomes after Surgical Resection Combined with Brachytherapy for Uveal Melanomas

Surgical Resection of Intraocular Tumors (Partial Transscleral Sclerouvectomy Combined With Mircoinvasive Vitrectomy and Reconstruction of the Eyeball) in Asian Patients: Twenty-Five Years Results

Underlying Ciliary Body Uveal Melanoma in a Patient with Chronic Lymphocytic Leukemia Presenting for Hyphema

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