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Transpupillary thermotherapy as primary treatment for small choroidal melanomas
D M Robertson1, H Buettner, S R Bennett
1Department of Ophthalmology, Mayo Clinic, Mayo Foundation, and Mayo Medical School, Rochester, Minn 55905, USA.
Objective:
To report the short-term follow-up results of eyes containing small choroidal melanomas that were treated with transpupillary thermotherapy.
Methods:
Twenty eyes with suspected small choroidal melanomas were treated with transpupillary thermotherapy using infrared light delivered from the diode laser.
Results:
The age of the patients ranged from 26 to 82 years. In 14 patients, there was documented growth of the melanoma before transpupillary thermotherapy. The tumor thickness ranged from less than 1.0 to 3.2 mm. Seven tumors were treated more than once. Follow-up ranged from 6 months to more than 3 years. Following treatment, the tumor thickness decreased in all cases, usually within 2 months. Progressive atrophy of tumor mass and loss of pigmentation within the tumor continued beyond 1 year of follow-up in some eyes. Complications included field defects, vascular changes, and macular abnormalities.
Conclusions:
Transpupillary thermotherapy of small choroidal melanomas is usually followed by early tumor shrinkage but is complicated by dense scotomas, nerve fiber bundle defects, and, occasionally, macular abnormalities. The short-term follow-up results suggest that transpupillary thermotherapy may arrest the growth of selected small melanomas.
Insights
Transpupillary thermotherapy effectively shrinks small choroidal melanomas, but potential complications like vision defects require careful consideration for this treatment.
Area of Science:
- Ophthalmology
- Oncology
Background:
- Choroidal melanomas are the most common primary intraocular tumors in adults.
- Early detection and treatment are crucial for preserving vision and preventing metastasis.
Observation:
- Twenty eyes with small choroidal melanomas were treated with transpupillary thermotherapy (TTT).
- Patients ranged in age from 26 to 82 years; 14 had documented tumor growth prior to TTT.
- Tumor thickness varied from <1.0 to 3.2 mm; seven tumors required re-treatment.
Findings:
- All treated tumors showed decreased thickness within two months post-TTT.
- Progressive tumor atrophy and depigmentation were observed beyond one year in some cases.
- Complications included visual field defects, vascular changes, and macular abnormalities.
Implications:
- TTT appears to arrest the growth of selected small choroidal melanomas.
- Despite early tumor shrinkage, potential visual complications necessitate careful patient selection and monitoring.
- TTT offers a viable, minimally invasive treatment option for early-stage choroidal melanomas.
