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Extrascleral extension of a choroidal melanoma after argon photocoagulation and transpupillary thermotherapy
  1. T Tsai1,
  2. J M O'Brien1,
  3. R Engstrom2,
  4. B R Straatsma2
  1. 1Ocular Oncology Unit, Department of Ophthalmology, University of California, San Francisco, California, USA
  2. 2Jules Stein Eye Institute, University of California, Los Angeles, California, USA
  1. Correspondence to: Joan O'Brien, MD, Ocular Oncology Unit, UCSF Department of Ophthalmology, 10 Kirkham Street, Box 0730, San Francisco, CA 94143, USA; aleja{at}itsa.ucsf.edu

https://doi.org/10.1136/bjo.86.3.358

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    The optimal management of small posterior choroidal melanomas remains controversial, especially for tumours located near the optic disc and fovea. Although with increasing rarity, argon laser photocoagulation continues to be used in the primary treatment of small tumours, despite data suggesting that other therapeutic methods may be more successful.1–4 More recently, transpupillary thermotherapy (TTT) has emerged as a therapeutic option for the primary treatment of small choroidal melanomas.5, 6 Initial results are promising, but like any new treatments, more widespread use and longer follow up are needed for a thorough assessment of its efficacy. As a cautionary reminder that additional study is required to define the potential complications of these treatments, we present a case of choroidal melanoma in which treatment with primary argon photocoagulation followed by TTT was associated with extrascleral extension of the tumour.

    Case Report

    A 38 year old woman presented with decreased visual acuity in her right eye. An ophthalmologist noted a pigmented choroidal lesion with associated subretinal fluid. The lesion was initially treated with argon laser photocoagulation, but within a month the decision was made to re-treat the lesion with TTT. Over the next 7 months, visual acuity deteriorated to 20/200. The lesion exhibited persistent elevation and subretinal fluid. …

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