Aims To report on the use of multi-dose photodynamic therapy (PDT) in the treatment of posterior uveal melanoma.

Methods Prospective case series. 18 patients with posterior uveal melanoma were treated with a minimum of three sessions of PDT. Mean tumour thickness was 1.92 mm (median 1.75, range 0.5–4.4 mm) while the mean basal diameter was 7.1 mm (median 6.3, range 5.2–11 mm). Patients were assessed for visual acuity, complications, tumour status and systemic metastases.

Results In 16 cases, the tumour regressed with stable or improved vision in 15 patients (83%) over a mean follow-up period of 28 months (median 26.5, range 12–44 months). One patient developed an edge recurrence on two occasions ultimately requiring proton beam therapy while one patient showed no response to PDT before being successfully treated with proton beam therapy. Two patients developed scleritis requiring a short course of systemic steroids. No patient developed metastatic disease in the study period.

Conclusions Posterior uveal melanomas may be successfully treated with high dose PDT with retention of good vision in the majority of cases, at least in the short-term. Longer follow-up is required to see if these encouraging results are maintained.