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Updated: Aug 4, 2025
Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography
Published on: December 2, 2022
Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in
Timothy G Murray1,2, Victor M Villegas1,3, Austin Bach4
1Miami Ocular Oncology and Retina, Miami, FL, USA.
Purpose:
This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA).
Methods:
An institutional review board-approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015.
Results:
A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%).
Conclusions:
Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.
Insights
Microincisional vitrectomy surgery with endolaser ablation offers excellent tumor control for small uveal melanomas. This approach, combined with genetic classification, preserves visual acuity and avoids radiotherapy.
Area of Science:
- Ophthalmology
- Oncology
- Surgical Innovation
Background:
- Uveal melanoma is a rare intraocular malignancy.
- Traditional treatments like radiotherapy can have significant side effects.
- The need for organ-sparing, vision-preserving treatment strategies is critical.
Purpose of the Study:
- To evaluate microincisional vitrectomy surgery (MIVS) with endolaser ablation for small uveal melanomas.
- To assess the utility of genetic tumor classification in guiding treatment.
- To determine if this approach can avoid radiotherapy while maintaining local tumor control and visual acuity.
Main Methods:
- Retrospective analysis of 58 patients with small uveal melanomas (<2.5 mm apical thickness).
- Procedures included MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide.
- Minimum follow-up of 60 months.
Main Results:
- High rate of molecular classification (96.5%) via FNAB.
- Initial visual acuity (VA) was 20/40 or better in 44.8% of eyes.
- Final VA improved to 20/40 or better in 82.8% of eyes.
- Excellent local tumor control achieved in 98.3% of cases.
Conclusions:
- MIVS with endolaser ablation is an effective treatment for small uveal melanomas.
- This technique achieves high rates of tumor control and visual acuity preservation.
- Genetic classification via FNAB is feasible and aids in treatment planning.
