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Updated: Sep 19, 2025
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Implantation and Evaluation of Melanoma in the Murine Choroid via Optical Coherence Tomography
Published on: December 2, 2022
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Inadvertent Scleral Perforation During Choroidal Melanoma Surgeries: Incidence, Risk Factors, Management, and
Hung-DA Chou1, Heinrich Heimann2, Bertil E Damato3
1From the Liverpool Ocular Oncology Centre (H.-D.C., H.H., R.H.), Liverpool University Hospitals Foundation Trust, Liverpool, UK; Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan and College of Medicine (H.-D.C.), Chang Gung University, Taoyuan, Taiwan.
American Journal of Ophthalmology
|June 2, 2025
Summary
Scleral perforation during choroidal melanoma surgery is rare, with a low incidence of 0.86% for plaque and 0.15% for marker surgeries. Immediate management leads to favorable outcomes, with no vision loss or tumor recurrence observed.
Area of Science:
- Ophthalmology
- Surgical Oncology
- Retinal Diseases
Background:
- Choroidal melanoma requires surgical intervention, often involving plaque or marker implantation.
- Inadvertent scleral perforation is a potential complication during these procedures.
- Understanding the incidence and risk factors is crucial for patient safety.
Purpose of the Study:
- To investigate the incidence, risk factors, management strategies, and outcomes of inadvertent scleral perforation during primary choroidal melanoma surgeries.
- To identify specific patient or surgical factors associated with scleral perforation.
- To evaluate the effectiveness of interventions for scleral perforation.
Main Methods:
- Retrospective analysis of 1081 patients undergoing primary choroidal melanoma surgery (ruthenium plaque or tantalum fiducial marker implantation) from 2011-2023.
- Review of clinical registry data to identify cases of scleral perforation.
- Analysis of perforation incidence, associated risk factors (myopia, thin sclera, equatorial location), immediate management (cryotherapy, suturing, intravitreal gas), and long-term outcomes.
Main Results:
- Scleral perforation incidence was 0.86% for plaque surgery and 0.15% for marker surgery.
- Myopia and thin sclera were identified in 5 of 7 perforation cases, all occurring in the equatorial region.
- Immediate management included cryotherapy, suturing, and intravitreal gas; 4 eyes required scleral buckling during plaque removal due to associated subretinal fluid.
- After a mean follow-up of 38 months, no retinal detachment occurred, visual acuity remained stable in 5/7 eyes, tumors regressed, and no seeding was observed.
Conclusions:
- Inadvertent scleral perforation during choroidal melanoma surgery is infrequent and associated with favorable outcomes when managed promptly.
- Risk factors include myopia, thin sclera, and equatorial surgical site.
- Recommendations include considering scleral buckling during plaque removal for perforation-related subretinal fluid and careful manipulation to avoid further scleral tears.
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