Resection of Intraocular Tumors (Partial Lamellar Sclerouvectomy) in the Pediatric Age Group

Abstract

To describe the outcome of intraocular tumor resection by partial lamellar sclerouvectomy (PLSU) in the pediatric age group. Retrospective, interventional case series. We included 37 patients who underwent PLSU for intraocular tumors under age 21 years. Medical records were reviewed for clinical, operative, and histopathologic features. Globe salvage, visual acuity, surgical side effects, tumor control, and tumor-related metastasis and death. The mean patient age was 9 years (median, 10; range, 0.25-17) and there were 22 (59%) females and 15 (41%) males. The tumor involved mainly the iris (n = 27; 73%), ciliary body (n = 7; 19%), or choroid (n = 3; 8%). The mean tumor basal dimension was 7 mm (median, 6; range, 3-15) and thickness was 3.6 mm (median, 3; range, 0.2-9.6). The histopathologic diagnosis was melanoma (n = 19; 51%), cyst (n = 5; 14%), medulloepithelioma (n = 4; 10%), melanocytoma (n = 3; 8%), lacrimal gland choristoma (n = 2; 5%), gliosis (n = 1; 3%), nevus (n = 1; 3%), hemorrhage (n = 1; 3%), and leiomyoma (n = 1; 3%). Intraoperative adverse effects included vitreous loss in 19 (51%) and hyphema in 4 (11%). Postoperative side effects included early transient hyphema in 9 (24%) and late cataract in 12 (32%). Local tumor recurrence was detected in 5 cases (13%) at mean interval of 28 months, including melanoma (n = 3) and medulloepithelioma (n = 2). Enucleation was necessary in 9 (24%) cases for recurrence in 3 (8%), prophylactic in eyes with high-grade malignancy in 5 (13%), and for blind painful eye in 1 (3%). Of the 28 salvaged eyes, final visual acuity was ≥ 20/40 in 18 (64%), 20/50 to 20/100 in 5 (18%), and <20/200 in 5 (18%). There were no cases of metastasis or death at a mean of 51 months of follow-up. A surgically challenging procedure, PLSU can achieve control of selected intraocular tumors. Medulloepithelioma responds poorly to local resection and in most cases enucleation is required. If the globe is salvaged, visual acuity is ≥ 20/40 in 64% of children. The authors have no proprietary or commercial interest in any of the materials discussed in this article.