Transpupillary thermotherapy (TTT) of choroidal melanoma, initially described to be used primarily in combination with plaque radiotherapy in 1995,1 2 has been subsequently used by several investigators, particularly in the United States as primary or sole therapy for “small” choroidal melanocytic lesions (melanomas or high-risk nevi with or without documented growth) (table 1). While the technique of TTT used by the investigators is similar (2–3 mm spot size, inclusion of 1 mm margin, overlapping spots, one to three applications 3–4 months apart), the inclusion criteria for selecting the patients to be treated with TTT has varied between series, although most investigators excluded tumours that were more than 4 mm in height.3 4

Following the initial encouraging results as primary therapy without brachytherapy,5 TTT rapidly increased in popularity because of …