VITREORETINAL SURGERY WITH ENDORESECTION IN THE MANAGEMENT OF HIGH POSTERIOR CHOROIDAL MELANOMAS

Jose Garcia-Arumi (Barcelona)

Purpose: Eyes with posterior choroidal melanomas exceeding 9 mm of thickness frequently are enucleated because of the potential complications of radiotherapy. The aim of this study was to evaluate the safety and efficacy of internal resection of these tumors.

Design: Prospective non-randomized clinical trial

Participants: Thirty-five consecutive patients affected of high posterior choroidal melanomas with a diameter inferior to 15 mm and a thickness superior to 9 mm were treated.

Methods: Pars plana vitrectomy and endoresection was performed in the 35 eyes. If the retina was not invaded by the tumor, a vitrectomy was performed, followed by posterior hyaloid dissection, 120º anterior retinotomy, endophotocoagulation 2 mm out of the tumor margin, melanoma removal with the vitrectomy probe, photocoagulation of the cellular remnants at the scleral bed, retinal reattachment with PFL and air, and silicone oil exchange. If the tumor invaded the retina, the laser was applied through the retina, and retina and tumor were removed together.

Results: Mean patient age was 42 years. Tumor thickness ranged from 9.1 to 12.8 mm, and tumor diameter from 8.9 to 14.8 mm. VA ranged from 20/400 to 20/20. In 21 cases the tumor had invaded the retina. An exudative retinal detachment was always associated. We were able to remove the whole tumor in the 35 eyes without intraoperative complications. The main postoperative complications were cataract (50%), retinal detachment (18 %), macular traction (16 %), epiretinal macular proliferation (8%) and branch vein occlusion (4 %). Histopathological studies showed a predominance of the epithelioid cell type. The postoperatory VA ranged between hand motions and 20/30, with a mean of 20/60. One recurrence was found at 2 years at the margin of the tumor, that was treated with transpupillary thermotherapy. No metastatic disease occurred. The follow-up ranged from 12 to 82 months (mean 43 months).

Conclusions: These data suggest that the internal resection of high posterior melanomas may conserve the eye and functional vision, and does not seem to increase the risk of metastatic disease. Longer folow-up is necessary to establish the safety of the procedure.


Back