Outcomes of primary endoresection for choroidal melanoma

Andre A C Vidoris,Marcia Lowen,Bruno F Fernandes,Jordan Isenberg,Andre Maia,Melina Morales,Rubens N Belfort

doi:10.1186/s40942-017-0096-5

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.

Highlights

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, with a reported incidence of 6–7 cases annually per million people [1,2,3]
Endoresection appears to be an acceptable alternative to enucleation for the treatment of posteriorlylocalized uveal melanoma, with excellent local control and eye salvage rates
Radiotherapy is generally administered to patients using ruthenium (Ru-106) or iodine (I-125) plaque brachytherapy, it may be delivered by charged particles or in the form of stereotactic radiotherapy [2, 5]

Summary

Introduction

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults, with a reported incidence of 6–7 cases annually per million people [1,2,3]. 80% of UMs occur in the choroid, and treatment of these tumors can either be radical—enucleation, for example—or conservative aiming to preserve the eye and as much vision as possible [2]. Conservative treatment approaches for choroidal melanoma include radiotherapy, phototherapy, and local resection. Plaque radiotherapy has been shown to be as effective as enucleation in preventing mortality from medium-sized choroidal melanomas [4], and it is the most common first-line treatment for smalland medium-sized tumors (height < 10 mm, diameter < 15 mm) [2]. For large UM tumors or those that do not respond well to radiotherapy, enucleation is the most frequent intervention [3, 5, 6]

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