Local excision of ciliary body tumors: a long-term prospective cohort study in China

Abstract

Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. Local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up. Twenty-two patients (22 eyes), who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. Localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages. After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities (BCVA) varied from 0.02 - 1.00, including 18 patients (81.82%) who had BCVA equal to or better than that before surgery. Fifteen patients (68.18%) had BCVA better than 0.3. Only two patients had intraocular pressure (IOP) of less than 10 mmHg and the other patients maintained normal IOP. Nine cases (40.91%) were given confirmed diagnosis of malignant melanoma, four (18.18%) of melanocytoma, six (27.27%) of nonpigmented ciliary epithelial adenoma, two (9.09%) of neurofibroma, and one (4.55%) of neurinoma. Twenty patients (90.91%) had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years after the operation. For some ciliary body tumors, especially in the early stages, local excision is an effective and safe method to save the vision and the eyeball.