The conservative management of choroidal melanoma

The results of 32 choroidal melanomas managed by observation, Iodine-125 scleral plaques and local surgical excision are presented. Initially, 12 patients were managed by observation, and of these three continued to be managed by observation alone. Fifteen patients were managed with Iodine-125 scleral plaques and followed for an average of 15 months. The tumour regressed in 11, remained the same in three, and recurred in one case. The final visual acuity remained within two Snellen lines of that recorded preoperatively in 10 patients. Fourteen patients underwent local excision with an average follow-up of 31 months. These cases, in general, had larger tumours. The final visual acuity was within two Snellen lines of the preoperative vision in four patients. Five eyes required enucleation at a later date. Four of the five enucleations occurred earlier in the series. The management of choroidal melanoma remains controversial. Various methods of conservative treatment are described and the indications for conservative management by observation, scleral plaque and local excision are discussed.