Original Articles
Transpupillary thermotherapy for small choroidal melanoma☆

https://doi.org/10.1016/S0002-9394(99)00063-XGet rights and content

Abstract

PURPOSE: To report the treatment of small choroidal melanoma with transpupillary thermotherapy.

METHODS: We examined a nonrandomized and uncontrolled series of 14 eyes of 14 patients who were followed up with serial ophthalmoscopy, ultrasonography, and photography. Transpupillary thermotherapy was performed upon documented evidence of tumor growth.

RESULTS: After transpupillary thermotherapy, mean follow-up ± SD was 16 ± 6.41 months (range, 7 to 28 months) with 10 eyes followed up for at least 1 year. The mean preoperative tumor height was 1.79 ± 0.59 mm (range, 0.78 to 2.60 mm). Six months after treatment, the mean height was 0.54 mm ± 0.57 mm (range, 0.00 to 1.16 mm). In 10 eyes, the treated lesion flattened entirely with a mean interval between treatment and flattening of 8.7 months (range, 3 to 21 months). Three patients required retreatment for lack of regression or recurrent growth. The average time to retreatment was 11 months (range, 5 to 15 months). No eye was retreated more than once. There were three amelanotic lesions, all treated in a single session without recurrence. Complications consisted of retinal hemorrhage, retinal vascular occlusion, retinal traction, exudative serous neurosensory detachment, vitreitis, and postoperative pain. The sole treatment failure occurred in an eye treated with a juxtapapillary tumor, with recurrence developing from a previously flattened lesion. This eye was enucleated 10 months after the single initial treatment. At the time of writing, there had been no tumor-related death.

CONCLUSIONS: Transpupillary thermotherapy may represent a viable treatment alternative for both pigmented and amelanotic small choroidal melanoma. Diligent follow-up is axiomatic because retreatment may be necessary. Recurrent tumors may develop from flat lesions. Juxtapapillary tumors may be at higher risk for recurrence. Definitive statements regarding the role of transpupillary thermotherapy in the management of small choroidal melanoma await 5-year and 10-year morbidity and mortality data.

Section snippets

Methods

Between November 1995 and March 1998, we evaluated 14 eyes of 14 patients with small choroidal melanoma treated with transpupillary thermotherapy in a nonrandomized, uncontrolled study. Each patient underwent a complete ophthalmologic examination, including refraction, tonometry, fundus examination with a dilated pupil, photography, and serial ultrasonography. Preoperative evaluation included medical consultation by an internist or family practitioner, chest radiograph (anteroposterior and

Results

Fourteen patients had a mean age of 54.4 ± 19.49 years (range, 21 to 77 years). All patients were white. There were 11 women and three men. Eight of 14 patients were initially examined with asymptomatic melanocytic lesions; six presented with decreased central visual acuity. A neurosensory detachment was present in association with the tumor in three eyes. Three of 14 eyes harbored relatively amelanotic lesions.

All patients had a minimum follow-up of 7 months. Average follow-up was 16 ± 6.41

Discussion

Hyperthermia has been used to enhance the therapeutic effect of radiation in the treatment of human choroidal melanoma,8, 9 as well as in a number of other nonocular cancers.10, 11, 12 Sources of ocular hyperthermia that have been employed include microwave,13, 14 ultrasound,15, 16 ferromagnetic thermoseeds,17 and localized current field.18 The precise mechanism by which hyperthermia enhances regression of neoplastic tissue is unknown; however, the relative selective effect of hyperthermia on

References (22)

  • J.A. Oosterhuis et al.

    Transpupillary thermotherapy in choroidal melanomas

    Arch Ophthalmol

    (1995)

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    ☆

    Supported in part by a departmental grant from Research to Prevent Blindness, Inc, New York, New York, and a National Institute of Health CORE Grant P30-EYO 6360, Bethesda, Maryland.

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