Failure of transpupillary thermotherapy (TTT) for choroidal melanoma: two cases with histopathological correlation
- The New York Eye Cancer Centre, New York City, The Departments of Ophthalmology and Laboratory Medicine, The New York Eye and Ear Infirmary, New York City, and The Department of Ophthalmology, The New York University School of Medicine, New York City, New York, USA
- pfinger{at}eyecancer.com
- Accepted 13 April 2000
Editor,—We are concerned about the widespread use of transpupillary thermotherapy (TTT). Two patients referred for evaluation after TTT failed to destroy their tumours underwent ophthalmic oncology evaluations, were diagnosed as having recurrent choroidal melanoma, and opted for enucleation as definitive treatment. Clinical history and examination revealed evidence of a TTT laser effect with partial chorioretinal attenuation and temporary reductions in tumour height. Histopathology revealed attenuation of the retina and choroid above viable appearing melanoma. Despite temporary reductions in tumour height, resistant and/or untreated choroidal melanoma at the deep margins grew, resulting in TTT failure.
CASE REPORTS
Case 1
A 47 year old man developed a small (8 × 7 × 1.9 mm) macular choroidal melanoma. Before TTT, the tumour's posterior margin was 2.25 mm from the foveola and the patient's visual acuity was 20/20 left eye (with metamorphopsia).
Three months after TTT, the apical tumour height decreased to 1.1 mm but the posterior margin remained elevated and was “heavily” retreated. Three months later a third TTT was administered, resulting in “no visible tumour”. At 30 months a crescent of pigmentation was noted along the posterior margin of the TTT scar (Fig 1) and treated immediately …
