Current Conservative Management Strategies for Uveal Melanoma

Abstract

Primary malignant intraocular tumors are rare. Of these, malignant melanomas represent about 75%; 20% are retinoblastomas and 5% are primary intraocular lymphomas. In the management of patients with malignant melanoma of the ciliary body and choroid (posterior uvea), treatment techniques have included not only surgery (enucleation and orbital exenteration in very advanced cases) but also photocoagulation, local resection, and cryotherapy. Since the introduction of radioactive plaque therapy about 35 years ago, this type of bulb-conserving procedure has become very popular and today is the most favored treatment in certain stages of malignant uveal melanoma. Other radiooncological methods like proton beam or helium ions have also proven to be effective in these ocular malignancies but can only be performed in selected places in few countries. Thermoradiation is still experimental and has to prove its routine clinical use and effectiveness. Because of promising results, local resection in combination with adjunctive radioactive plaque therapy probably seems to be used more often in the future. The primary goal of treatment is not only conservation of the eye with acceptable vision, but also to gain the same prognosis as with enucleation. Despite many reliable treatment results, authorities still disagree whether enucleation or conservative treatment offers the best prognosis, although many retrospective studies have suggested that the method of treatment makes no difference in the systemic prognosis.