Outcomes of primary endoresection for choroidal melanoma

Abstract

PurposeTo review long time treatment results in patients with small or medium sized choroidal melanoma who underwent surgical tumor endoresection as a primary treatment when plaque radiotherapy was unable and patients declined enucleation.Materials and methodsPatients were evaluated for best corrected visual acuity (BCVA), and underwent biomicroscopy, indirect ophthalmoscopy, retinography and ultrasound as well as the usual systemic workup. Study inclusion required the absence of scleral invasion or metastasis and an anterior margin not exceeding the pars plana or the ciliary body. Surgery consisted of a clear lens phacoemulsification with a PC-IOL, and a 23-gauge pars plana vitrectomy with anterior vitreous shave, lesional choroidal endodiathermy, followed by 23-gauge probe tumor endoresection and continuous endolaser. Patients were followed at post-operative 1 day, 1 week, 1, 3, and 6 months and then every 6 months with a complete ophthalmological exam including ultrasound biomicroscopy and systemic follow-up at 3, 6 and every 6 months thereafter.ResultsFourteen patients with choroidal melanoma were included the study. Pre-operative BCVA ranged from 20/20 to hand motion (HM): 20/20 (n = 2); 20/60 (n = 1); and HM (n = 10). Pathological analysis confirmed the diagnosis of uveal melanoma in all cases. Mean follow-up was 54.5 months (45–66 months) with a final BCVA ranging from 20/60 to HM: 20/60 (n = 1); 20/60 to 20/200 (n = 10); and HM (n = 2). The eye retention rate in our study was 100%. No intraocular recurrence was observed. One patient died 12 months after surgery from metastatic disease.ConclusionEndoresection appears to be an acceptable alternative to enucleation for the treatment of posteriorly-localized uveal melanoma, with excellent local control and eye salvage rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0096-5) contains supplementary material, which is available to authorized users.

Surgical Approach in Intraocular Tumors

“…Complications such as increased intraocular pressure, vitreous hemorrhage, epiretinal membrane, phthisis bulbi, hypotonia, macular hole, choroidal neovascularization, proliferative vitreoretinopathy, and endophthalmitis may also occur after endoresection. 13,14,64,65,68,69,70,71,72,73,74,75 A summary of the complications reported in previous publications related to endoresection is shown in Table 5. Metastasis rates of 0-20% and mortality rates of 0-18.2% have been reported after endoresection of choroidal melanomas.…”

Prevention and treatment of the toxic tumour syndrome following primary proton beam therapy of choroidal melanomas

“…According to the literature, the metastatic disease in patients undergoing endoresection for choroidal melanoma was observed in 1.9-15.5% of cases after a mean follow-up of 41-102.5 months [12,13,17,21,30]. However it is unclear whether metastatic disease is of the iatrogenic origin or is associated with the presence of circulating malignant cells which seeded liver before surgery [20,32,33]. Damato et al, who observed metastatic disease only in one among 52 patients 41 months postoperatively, stated that endoresection did not increase the rate of metastases [12].…”

“…To our knowledge, there are a few publications concerning the endoresection as a prevention of TTS following the choroidal melanoma irradiation [8,9]. Most reports present the results of endoresection in eyes with established TTS or analyse the results of endoresection as a primary method of treatment with or without adjuvant brachytherapy [5,9,[12][13][14][15][16][17][18][19][20].…”

Proceedings of the Association for Research in Vision and Ophthalmology and Champalimaud Foundation Ocular Oncogenesis and Oncology Conference

“…For the past 8 years, his team has worked to improve ocular cancer outcomes by promoting early diagnosis and efficient care despite substantial financial constraints. He described the following initiatives: the mobile phone WhatsApp-based ocular oncology “second opinion” app, called “Oncophone”; YouTube-based ocular oncology videos for patients and ophthalmologists (www.cancerocular.com.br); the ocular oncology center in the Amazonian region; and some low-cost strategies for tumor treatment, including primary endoresection for uveal melanoma3 and laser for conjunctival tumors 4…”