148 - Surgical resection of choroidal melanoma

Abstract

A choroidal melanoma can be excised en bloc through a scleral window (exoresection) or transretinally with a vitreous cutter (endoresection). Primary exoresection may involve a choroidectomy, cyclochoroidectomy, or an iridocyclochoroidectomy. These procedures are indicated for tumors that are too large for radiotherapy. They are usually performed with adjunctive radiotherapy, which circumvents the need for wide safety margins, thus reducing morbidity. Primary endoresection is mostly performed to avoid radiation-induced optic neuropathy. At some centers, this procedure is preceded by neoadjuvant radiotherapy; however, we believe this causes unnecessary morbidity because the long-term local tumor recurrence rate after endoresection alone is less than 5%. Survival after surgical resection does not appear to be worse than after radiotherapy. Concerns regarding systemic tumor dissemination seem unfounded. The most common complication is rhegmatogenous retinal detachment, which is usually treatable successfully. For these reasons, in selected cases, surgical resection offers the best chances for eradicating the threat of metastasis while conserving vision.