Surgical Resection of Intraocular Tumors (Partial Transscleral Sclerouvectomy Combine With Mircoinvasive Vitrectomy and Reconstruction of the Eyeball) in Asian Patients: Twenty-Five Years Results

Abstract

Objective: To describe the outcome of intraocular tumor resection by partial transscleral sclerouvectomy (PTSU) combine with mircoinvasive vitrectomy and reconstruction of the eyeball (MVRE) in Asian patients. Design, Methods and Participants: This retrospective, interventional cohort study included 366 patients who underwent PTSU combine with MVRE for intraocular tumors of the adult and pediatric age groups. Medical records were reviewed for clinical, operative, and histopathologic features. Main Outcome Measures: Globe salvage, best corrected visual acuity (BCVA), surgical side effects, tumor control, and tumor-related metastasis and death. Results: The mean follow-up was 87 months (median, 66; range, 1-303). Among the 366 patients, the mean age was 8.5 years (median, 7; range, 1-19) in 37 pediatric patients, and was 43 years (median, 42; range, 20-51) in 329 adult patients. The tumor mainly involved the ciliary body (n=136; 37.2%) and choroid (n=86; 23.5%). The globe salvage rate was 81.1% in the pediatric age groups (<20 years), and 93.6% in the adult group (≥20 years), respectively. Of the 338 salvaged eyes, final BCVA was 20/20 to 20/40 in 16 (4.7%), 20/40 to 20/80 in 58 (17.2%), 20/80 to 20/200 in 160 (47.3%), and ≤20/200 in 104 (30.8%). Early side effects included corneal edema in 28 (7.7%), hyphema in 46 (12.6%) and vitreous hemorrhage in 76 (21%). Postoperative side effects included proliferative vitreoretinopathy (PVR) in 67 (18.3%), late cataract in 42 (11.5%), glaucoma in 18 (5%). Local tumor recurrence was detected in 20 cases (5.5%) at mean interval of 23.6 months, including melanoma (n=19) and medulloepithelioma (n=1). Enucleation was necessary in 28 (7.7%) cases for recurrence in 15 (53.6%), prophylactic in eyes with high-grade malignancy in 5 (17.8%), and for blind painful eye in 8 (28.6%). Kaplan-Meier estimated of the 5, 10-year metastasis rate and metastasis related death (95%CI) in 213 UM patients were 3.2% (1.4%-7.0%), 6.9% (3.8%-12.3%); and 3.5% (1.6%-7.6%), 7.6% (4.2%-13.5%), respectively. Conclusions and Relevance: As a surgically challenging procedure, PTSU combine with MVRE offers several theoretical advantages over enucleation and radiotherapy. It can achieve control of most intraocular tumors, preserve useful vision, and maintain a cosmetically normal eye. Funding Statement: The National Natural Science Foundation of China (Nr. 81272981), the Beijing Natural Science Foundation (Nr. 7151003) provided financial support. Declaration of Interests: All authors declare that they have no conflict of interest in this manuscript. Ethics Approval Statement: The study was approved by the Institutional Review Board of Beijing Tongren Hospital, and written informed consent was obtained from all participants.