Trans-scleral local resection of toxic choroidal melanoma after proton beam radiotherapy.
Br J Ophthalmol
; 98(6): 775-9, 2014 Jun.
Article
en En
| MEDLINE
| ID: mdl-24568869
AIM: To report on trans-scleral local resection of choroidal melanoma for exudative retinal detachment and neovascular glaucoma (toxic tumour syndrome) after proton beam radiotherapy (PBR). METHODS: A non-randomised, prospective study of secondary trans-scleral local resection of choroidal melanoma for exudative retinal detachment with or without neovascular glaucoma after PBR. The patients were treated at the Liverpool Ocular Oncology Centre between February 2000 and April 2008. The trans-scleral local resection was performed with a lamellar-scleral flap, using systemic hypotension to reduce haemorrhage. RESULTS: 12 patients (six women, six men) with a mean age of 51â
years (range 20-75) were included in this study. The tumour margins extended anterior to ora serrata in six patients. On ultrasonography, the largest basal tumour dimension averaged 12.4â
mm (range 6.8-18.1) and the tumour height averaged 7.1â
mm (range 4.2-10.7). The retinal detachment was total in seven patients. Neovascular glaucoma was present in four patients. The time between PBR and local resection had a mean of 17.4â
months (range 1-84). The ophthalmic follow-up time after the local resection had a mean of 46.2â
months (range 14-99). At the latest known status, the eye was conserved in 10 patients, with a flat retina in all these patients and visual acuity equal or better than 6/30 in four patients. The reasons for enucleation were: patient request for enucleation when rhegmatogenous retinal detachment complicated the resection (one patient) and phthisis (one patient). CONCLUSIONS: Exudative retinal detachment, rubeosis and neovascular glaucoma after PBR of a choroidal melanoma can resolve after trans-scleral local resection of the tumour. Our findings suggest that these complications are caused by the persistence of the irradiated tumour within the eye ('toxic tumour syndrome').
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Esclerótica
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Procedimientos Quirúrgicos Oftalmológicos
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Desprendimiento de Retina
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Glaucoma Neovascular
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Neoplasias de la Coroides
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Terapia de Protones
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Melanoma
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Observational_studies
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Prognostic_studies
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Br J Ophthalmol
Año:
2014
Tipo del documento:
Article
Pais de publicación:
Reino Unido