Primary transpupillary thermotherapy for small choroidal melanoma.

Abstract

BACKGROUND:

The treatment of small choroidal melanoma is controversial. Thermal laser-induced treatment is utilized by some centers but there is still sparse literature about the subject, mainly with short-term follow-up time. The efficacy of transpupillary thermotherapy (TTT) for the treatment of small choroidal melanomas was evaluated.

METHODS:

A prospective nonrandomized study of transpupillary thermotherapy for small (thickness ≤ 4.0 mm and basal diameter ≤ 12 mm) pigmented choroidal melanomas presenting either growth or risk factors for growth and metastasis. Ophthalmoscopic aspect, tumor control, visual acuity and complications were evaluated.

RESULTS:

Twenty-seven patients were treated; mean age 61 years; mean tumor thickness before treatment was 2.7 mm and base was 8.52 mm. After a mean of three treatment sessions and 45-month follow-up, mean tumor thickness decreased significantly to 1.34 mm (p < 0.001) and mean tumor base to 5.48 mm (p < 0.001). Complications were observed in 12 patients (44%) and included retinal vascular occlusion, optic disc atrophy, retinal traction, vitreous hemorrhage, rhegmatogenous retinal detachment, and maculopathy. Lesions touching the optic disc were associated with a significantly higher rate of disc atrophy after treatment (60% vs. 40%, p=0.030). Visual acuity remained the same in nine eyes (33%), improved in five (19%) and decreased during the first 6 months after treatment in 13 eyes (48%). Complete tumor control without recurrence was observed in 25 patients (93%). Recurrence at tumor margin was detected in two (7%). All eyes were preserved. One patient had tumor-related death.

CONCLUSIONS:

TTT is an effective treatment in the management of selected small choroidal melanoma. Decrease in visual acuity occurred early after treatment mainly associated with subfoveal and perifoveal tumors treatment and complications. Long-term randomized studies are still needed in order to better situate this treatment.

• Authors: Martha Motono Chojniak, Rubens Chojniak, Ines Nobuko Nishimoto, Norma Allemann, Clélia Maria Erwenne
• Journal: Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie (Graefes Arch Clin Exp Ophthalmol) Vol. 249 Issue 12 Pg. 1859-65 (Dec 2011) ISSN: 1435-702X [Electronic] Germany
• PMID: 21713533 (Publication Type: Journal Article)

Chemical References

• Indocyanine Green

Topics

• Adult
• Aged
• Aged, 80 and over
• Choroid Neoplasms (pathology, therapy)
• Female
• Fluorescein Angiography
• Humans
• Hyperthermia, Induced
• Indocyanine Green
• Male
• Melanoma (pathology, therapy)
• Middle Aged
• Prospective Studies
• Pupil
• Risk Factors
• Treatment Outcome
• Visual Acuity (physiology)