Uveal tumour resection

Abstract

Aim-To review the ocular retention rates, visual results, and metastases in uveal tumours managed with eye wall resection techniques. Methods-This was a retrospective analysis of consecutive local uveal tumour resections performed by a single surgeon. All enucleation specimens were reviewed by one author. Both parametric and non-parametric analysis of data were performed. Results-138 eyes were scheduled for eye wall resection surgery. The mean age was 52 years (range 11-86 years). Tumours involved predominantly the iris in 14 cases, iris-ciliary body in 57, ciliary body alone in 18 patients, and in 49 cases the choroid was involved (ciliochoroidal, irisciliary body-choroid, or choroid). 125 eyes harboured melanomas; posterior tumours were more likely to have epithelioid cells (p<0.05). The mean follow up was 6 years. The mean clock hours in iris and irisciliary body tumours was 3.5. In tumours that involved the choroid the mean largest diameter was 12.9 mm and the mean thickness 8.5 mm. 105 of 138 (76%) eyes were retained. Histological assessment of surgical margins did not correlate evidence of tumour in enucleated eyes or metastatic disease. Surgical margins of more anterior tumours were more likely to be clear on histological evaluation (p<0.05). Approximately 53% of retained eyes had a final visual acuity of >20/40; visual results were significantly better in more anteriorly located tumours (p<0.05). All retained iris tumour cases had >20/40 final visual acuity. In tumours that involved the choroid nine of 31 retained eyes kept that level of visual acuity. Eight patients developed metastases; all metastatic events developed in patients with tumours that involved the choroid, and seven of eight were mixed cell melanomas. Conclusions-76% of eyes were retained and 53% of these had a final visual acuity of >20/40. Only 7% of uveal melanoma patients developed metastatic disease with a mean follow up of 6 years. Survival did not appear to be compromised with eye wall resection and in very thick, more posterior melanomas it appeared that ocular retention and visual results were better than with radiation alone.

Local Tumor Control, Visual Acuity, and Survival After Hypofractionated Stereotactic Photon Radiotherapy of Choroidal Melanoma in 212 Patients Treated Between 1997 and 2007

“…Although in some patients enucleation is still required because of large size of the tumor at the time of presentation, eye-preserving approaches have shown to be equally successful regarding overall survival and metastasis-free survival (3,4). Depending on tumor size and location, therapeutic strategies include radiotherapy, surgical techniques, or a combination of both (5)(6)(7)(8)(9)(10)(11).…”

Proton Teletherapy of Uveal Melanoma

“…In very thick (>9 mm), choroidal or ciliochoroidal melanomas that are less than 15 mm in diameter, several groups, including ourselves, have found that there appears to be less ocular morbidity with eyewall resection followed by adjunctive radiation than with either radioactive plaque or proton radiation alone. [10][11][12] We have excluded patients from proton treatment in which over 40% of the eye volume is involved by tumor, patients who have neovascular glaucoma before treatment, when there is a large, extraocular, localized orbital extension involving the orbit, or eyes that are painful and blind. In those latter settings, we have not been able to salvage a useful eye.…”

Recurrent choroidal melanoma after transscleral local resection with diffuse vitreous seeding

“…Risk factors for local recurrence include epithelioid cell type, posterior tumour in proximity to disc and fovea, and lack of adjunctive plaque radiotherapy [1,2]. In the first case, the melanoma was posteriorly situated but was of predominantly spindle-cell type.…”

“…Tumour recurrence, at the margins of the surgical coloboma has been reported in 3-32% of cases usually as a mass lesion [1][2][3][4]. Diffuse intraocular spread and vitreous seeding are rare.…”