Aims-The eVect of transpupillary thermotherapy (TTT) on human choroidal melanomas was investigated by means of histopathology. Methods-Before enucleation TTT was performed in 11 eyes with a xenon arc photocoagulator with a red filter or a diode laser at 810 nm. The exposure time was 1 minute; the estimated temperature at the top of the tumour was about 65°C. Results-Seven of 11 tumours developed necrosis to a maximum depth of 3.9 mm with a sharp demarcation between the necrotic and the viable part of the tumour. The depth correlated with penetration of heat into the tumour. Scattered small haemorrhages in the transitional zone between the necrotic and the viable part of the tumour were observed in three eyes but large haemorrhages were absent. Ocular media were not aVected owing to the low rate of absorption of radiation at 810 nm. TTT did not cause significant scleral damage. Intrascleral tumour cells with a viable appearance were observed in one eye, where the tumour was almost totally necrotic. Conclusion-Results show that TTT has potential as a conservative therapeutic treatment for choroidal melanomas. (Br J Ophthalmol 1997;81:234-239) Enucleation as treatment of choroidal melanomas is partly replaced by radiotherapy with charged particles or brachytherapy with ruthenium-106 or iodine-125. Irradiation is associated with failures and complications since approximately 50% of eyes develop late complications after brachytherapy.

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