Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma

Abstract

Purpose: This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA). Methods: An institutional review board–approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015. Results: A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%). Conclusions: Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.

Predicting Malignant Transformation of Choroidal Nevi Using Machine Learning

“… 48 Murray et al retrospectively evaluated a case series of small UM undergoing early fine-needle aspiration biopsy combined with pars plana vitrectomy and endolaser ablation. 47 The study found no patients developed metastasis in the follow up period, suggesting that early treatment may lower the risk of mortality compared to observation alone.…”

“… 45 , 46 Despite the availability of effective treatments for the primary tumor, more than 50% of UM patients develop metastatic disease suggesting that UM may metastasize prior to the time of treatment. 45 , 47 Consequently, there is a need for identifying and treating small UM to minimize the number of melanocytic choroidal tumors that are observed and subsequently grow during the observation period. The importance of treating small UM was additionally emphasized by Eskelin et al, who measured doubling time in both untreated and treated metastatic UM and proposed that most metastases begin up to 5 years prior to primary tumor treatment.…”

Case Report: Two Genetically Distinct Choroidal Melanomas in the Same Eye Treated with Endolaser Therapy

“…6 Combined pars plana vitrectomy with endolaser treatment has also shown to be an efficient method to treat these small melanomas, with a recurrence rate of only 1.7%. 7 Medium-sized tumors (<10 mm in apical height and <15 mm in basal diameter) are treated with radiation therapy and plaque brachytherapy using iodine-125. 4 Plaque radiotherapy can be custom designed to treat any tumor size up to 12 mm in thickness.…”

“…It is most often used in addition with plaque radiotherapy 6 . Combined pars plana vitrectomy with endolaser treatment has also shown to be an efficient method to treat these small melanomas, with a recurrence rate of only 1.7% 7 …”