Combined surgery and cryotherapy for scleral invasion of epithelial malignancies

Three patients with epithelial malignancies of the ocular adnexa, a basal cell carcinoma, a squamous cell carcinoma, and a malignant melanoma, are presented. All three had invasive tumors with scleral involvement. In an attempt to preserve the globe, treatment consisted of local surgical excision without lamellar or full thickness sclerectomy , followed by cryotherapy utilizing a double cycle freeze-thaw- refreeze technique to the underlying scleral bed and areas of suspected residual tumor. All three patients have been followed from 24 to 37 months without change in their initial visual acuity and without clinical recurrence of tumor. Although this combined surgical and cryosurgical approach cannot be advocated as a primary mode of therapy, it may offer a useful alternative to enucleation or exenteration in selected patients with ocular invasion of tumor in whom more radical surgery may be visually incapacitating or not otherwise feasible.