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INTRODUCTION: We describe a technique using an sclerocorneal endograft sewed through the cornea to solve late scleromalacia following exoresection and brachytherapy of a ciliary body melanoma. METHODS: Vitrectomy ports were placed. A perforating 400-micron trepan keratoplasty of the cornea was performed allowing the prepared donor graft to be inserted and sutured in place. Intravitreal Perfluorocarbon liquid (PFCL) was used to stabilize the pressure throughout and maintain the graft in place. Once sutured in place, the PFCL was removed and 5000cs of silicone oil introduced. An amniotic membrane was placed surrounding the scleromalacia. The cornea was closed with running sutures. RESULTS: At one month, the anterior segment optical coherence tomography showed successful endograft placement with no aqueous humor leakage nor hypotony. Currently, the conjunctiva is becoming slightly thicker due to light inflammation, and the eye has recovered the whiteness at the scleromalacia. CONCLUSIONS: This internal graft technique provides advantages when dealing with poorly healing radiated tissue and reduces the risk of post-operative aqueous humor leakage. Surgeons may consider this approach in cases with a high risk of poor healing or complications resulting from lack of tissue.

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Surgical resection is widely used to treat small tumours located in the iris and the ciliary body, due to the accessibility of these sites. By contrast, surgical removal of choroidal tumours is substantially more challenging, which is why this procedure is performed only at specialised centres. In the present article, we review the literature on surgical resection of choroidal tumours, which can be performed as endoresection (ab interno) or transscleral resection (ab externo). An important aim of this review is to describe and compare the two approaches in terms of visual outcomes, survival rates, and complications. Both approaches are indicated for the removal of large tumours (thickness > 8 mm) with small base diameters. Surgical resection of the tumour allows clinicians to obtain valuable histopathologic and cytogenetic data from the specimen and eliminates the risks associated with radiotherapy. However, both of these surgical approaches are technically challenging procedures involving the risk of severe early and late postoperative complications.

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Currently, brachytherapy is the most commonly used therapeutic approach for uveal melanomas. Surgical resection by means of endoresection or exoresection is an alternative approach. The present report recounts our experience over 15 years in the treatment of uveal melanoma using a combined approach of resection surgery with brachytherapy. This is a single-center observational retrospective cohort study in which we describe clinical outcomes, complications and survival in 35 cases of melanoma of the iris or the ciliary body after a combination of surgery and brachytherapy or brachytherapy alone. Local treatment of the tumor was successful in all cases with surgery and brachytherapy. The most frequent complications were scleromalacia, bullous keratopathy, retinal toxicity, cataracts, hypotonia, and photophobia. There were three cases of recurrence, all of which were found in the group of patients who had received brachytherapy alone, and in one case we had to perform a secondary enucleation due to tumor growth after brachytherapy. At present, only one patient has died during follow-up due to liver metastases six years after the start of treatment. In carefully selected patients, this approach can be effective and safe, as long as a close follow-up is carried out after surgery.

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Uveal melanoma is the most common intraocular malignant tumor, with the choroid being the most common site. Management of choroidal melanoma has evolved greatly over the past years. In the past, the conventional method of treatment was enucleation of the affected eye with a debate regarding the effect of enucleation to promote or prevent metastasis. However, nowadays, there are many therapeutic options available including plaque radiotherapy, proton beam radiotherapy, argon laser photocoagulation, transpupillary thermotherapy, stereotactic radiotherapy using gamma knife, enucleation, and surgical resection of the tumor whether through transscleral approach "Exoresection" or less commonly through internal resection approach "Endoresection." The indications and complications of each technique are reviewed. Although radiotherapy is the primary treatment of choroidal melanoma in most ocular oncology centers, it is used as an adjuvant therapy in combination with surgical resection. Preoperative stereotactic radiotherapy before endoresection and brachytherapy to the surgical bed in both exo and endoresection can effectively decrease the recurrence rate. In this article, we will focus on surgical resection of choroidal melanoma whether endoresection or exoresection. We collected data published in indexed journals and related books.

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This article explores the range of tumor specimens that may be submitted to ophthalmic pathology. The handling of complex enucleation and exenteration is described along with smaller eyelid, conjunctival and corneal specimens. The importance of a good understanding of the unique anatomy of the ocular region and detailed clinical information is emphasized as this results in the taking of appropriate blocks for histology and consequently clinically helpful reports. Recommendations for handling specimens where further tissue is required for molecular studies is discussed.

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Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. There are two surgical resection techniques: Transscleral resection or "Exoresection" via a partial lamellar sclerouvectomy and "Endoresection" via a pars plana vitrectomy. While exoresection is more applicable to anteriorly located tumors with ciliary body and/or iris involvement, endoresection is more suitable for posteriorly located tumor without ciliary body involvement. Both approaches are suitable for large tumors with >8 mm in thickness. In general, eyes containing these large tumors have a very dismal prognosis regarding long-term visual function, eye retention, and irradiation-induced side effects. By removing the tumor burden from the eye, histopathologic and cytogenetic information of the tumor is available and complications associated with the so-called toxic tumor syndrome are avoided. However, both types of surgical resection are challenging surgical procedures, bearing the risk of early and late postoperative complications.

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PURPOSE: To evaluate the results and complications of exoresection via a partial lamellar sclerouvectomy (PLSU) procedure for uveal tumors performed by a novice surgeon without help from an experienced surgeon. METHODS: Medical records of 22 patients who underwent exoresection for uveal tumors between February 1999 and January 2009 were evaluated retrospectively. Exoresection was considered for tumors with their epicenter in the iris or in the ciliary body. RESULTS: Twenty-two patients with a mean age of 45.9 years (range: 19-72 years) were included in this study. The histopathologic diagnosis was uveal malignant melanoma in 16 patients, iridociliary nevus in 2 patients, iris nevus in 2 patients, and iridociliary melanocytoma in 2 patients. Postoperative complications included cataract in 11 patients (50%), scleral thinning in 4 patients (18%), vitreous hemorrhage in 2 patients (9%), hyphema in 2 patients (9%), secondary glaucoma in 2 patients (9%), iridodialysis in 1 patient (4.5%), bullous keratopathy in 1 patient (4.5%), and posterior synechiae in 1 patient (4.5%). At a mean follow-up of 40.1 months (range: 1-98 months), there were no recurrences or metastatic events. CONCLUSIONS: Exoresection seems to be an effective treatment option in selected cases of iridociliary and ciliary body tumors. Novice surgeons with limited training in PLSU should not discourage themselves from doing this type of surgery. Several postoperative complications inevitably occur and require frequent patient monitoring.