The surgical approach to the management of anterior uveal melanomas

Surgical excision of peripheral iris or ciliary body melanomas can be performed antero-posteriorly (irido-cyclectomy) with mydriasis or postero-anteriorly (cyclo-iridectomy) with miosis. The aim of this study was to evaluate the results of both surgical techniques.

Patients were enrolled in the study if they underwent irido-cyclectomy or cyclo-iridectomy for iris and/or ciliary body melanoma at the Liverpool Ocular Oncology Centre between 1993 and 2012.

The 24 patients (8 male, 16 female) had a median age of 57 years. The largest median basal tumour diameter and the median tumour thickness were 4.8 and 2.2 mm, respectively. The resection was performed antero-posteriorly in 9 (37%) patients and postero-anteriorly or circumferentially in 15 (63%). Nine tumours contained epithelioid cells. Genetic studies were performed in 10 patients, showing chromosome 3 loss in two. Postoperative complications included hypotony in 9 (37%) patients, cataract in 8 (33%), hyphaema in 8 (33%), cyclodialysis in 1 (4%), wound dehiscence in 1 (4%) and bullous keratopathy in 1 patient (4%). The median follow-up time was 2.4 years. The last known visual acuity was 6/6-6/12 in 20 (91%) patients and 6/18-6/60 in 2 (9%), with 2 (8%) requiring secondary enucleation. Local tumour recurrence developed in 1 patient (4%). Two (8%) patients died of metastatic disease.

Surgical resection of peripheral iris melanomas achieves high rates of visual conservation and local tumour control and may be the preferred option when tissue is required for laboratory studies.