Transpupillary thermotherapy of choroidal melanoma with or without brachytherapy: a dilemma
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
- Jan EE Keunen, Department of Ophthalmology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, Netherlands
Transpupillary thermotherapy (TTT) is a new approach to the treatment of choroidal melanoma with heat. The early treatment results seem favourable with regard to local tumour control and retained visual acuity; no early metastasis was found.1-3 The reported rate of complications is low.2 3
The heat treatment is performed with a temperature calculated at 45–65°C, induced by an infrared diode laser (810 nm) with a large beam diameter (3 mm) and a long exposure time of 1 minute per application. These factors promote a deep penetration of heat into the choroidal melanoma. The result is tumour necrosis up to 3.9 mm deep and occlusion of blood vessels in the treated area as shown on histopathology.4 Depending on the pigmentation of the tumour, the energy is raised or lowered stepwise until the desired effect occurs. The tumour is treated by overlapping applications extending beyond the margin of the tumour. The exposure time should not be shortened to less than 1 minute, as it takes 40 seconds to reach a temperature at subcoagulation level.
TTT is performed as an outpatient procedure …
