Eye wall resection in the management of uveal neoplasms

Management of intraocular tumors, specifically uveal melanoma, is a matter of controversy. The treatment of these ocular neoplasms varies from observation to enucleation, irradiation (cobalt plaque and proton-helium particle) and eye wall resection. Over the last 18 years, we have developed two techniques for surgical resection of intraocular tumors. An encircling laser photocoagulation and limited scatter photocoagulation with laser precede both procedures. The operation is performed under hypotensive anesthesia in both techniques. The external approach is used for anteriorly located tumors (ciliary body and anterior choroidal lesions) and makes use of an eye basket to stabilize the operation area. A partial dissection of the sclera is performed, then the tumor is removed en bloc with the sclera, choroid and retina. The remaining sclera is resutured to cover the resected area. A modification of this technique is used for a limited excision of choroidal and retinal tissue for the purpose of biopsy and tissue analysis. The internal approach (developed four years ago) has been successfully used for removal of malignant and benign lesions located posterior to the equator and around the optic nerve. This technique uses vitrectomy instrumentation in addition to endolaser. Detailed surgical technique and results achieved in both procedures are described.