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Primary photodynamic therapy with verteporfin for pigmented posterior pole cT1a choroidal melanoma: a 3-year retrospective analysis
  1. Ido Didi Fabian1,2,
  2. Andrew W Stacey1,3,
  3. Lamis Al Harby1,
  4. Amit K Arora1,
  5. Mandeep S Sagoo1,4,5,
  6. Victoria M L Cohen1,4,5
  1. 1Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2Ocular Oncology Service, Goldschleger Eye Institute, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
  3. 3Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  4. 4NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
  5. 5Institute of Ophthalmology, University College London, London, UK
  1. Correspondence to Dr Ido Didi Fabian, Moorfields Eye Hospital, London EC1V 2PD, UK; didifabian{at}gmail.com

Abstract

Aims To investigate the outcomes of primary photodynamic therapy (PDT) for pigmented posterior pole cT1a choroidal melanoma.

Methods Retrospective interventional consecutive case series of 26 patients (26 eyes) with pigmented posterior pole cT1a choroidal melanoma, who were treated with 3 sessions of PDT and followed-up thereafter.

Results Included were 11 males and 15 females that presented at a median age of 66 years (mean: 64) with transformed naevi (n=11) or suspicious lesions (n=15) with ≥3 risk factors for growth, with lipofuscin in all. In all cases, diagnosis was clinically based (no tissue biopsy). Tumour control was achieved in 16 (62%) patients in a median follow-up time of 29 months (mean: 27). Ten patients failed treatment by form of radial expansion, diagnosed in a median time of 13 months (mean: 12) from last treatment. By Kaplan-Meier analysis, success rate after 1, 2 and 3 years was 85%, 59% and 51%, respectively. On statistical analysis, number of suspicious features was found to be the only risk factor predicting failure (P=0.046). One patient developed macula-sparing branch retinal artery occlusion after treatment. Following PDT, subretinal fluid resolved in all cases and visual acuity significantly improved in all treatment-success cases (P=0.043). There were no cases of metastatic spread.

Conclusion Primary PDT resulted in tumour regression of small, pigmented choroidal melanoma in 62% after a mean of 27 months. Treatment was more effective in tumours with three or less risk factors for growth, and resulted with fluid elimination and significant improvement in vision in treatment-success cases.

  • Neoplasia
  • Treatment Lasers

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Footnotes

  • Contributors IDF had substantial contribution to the design of the work, collection and analysis of the data, drafting the work, final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AWS had substantial contribution to the design of the work, collection and analysis of the data, drafting the work, final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LAH had substantial contribution to the acquisition, collection and analysis of the work, drafting the work, final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AKA had substantial contribution to the conception of the work, collection and analysis of the data, drafting the work, final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MSS had substantial contribution to the conception of the work, collection and analysis of the data, drafting the work, final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. VMLC had substantial contribution to the design of the work and analysis of the data, significantly drafting the work, final approval of the version published and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the Moorfields Eye Hospital institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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