[The gas hypertension technique in enucleation for ocular melanoma]

Using the hypertensive gas technique, before touching the melanoma eye for enucleation intraocular pressure is raised to maximum by an intravitreal gas injection (average 1.2 ml of perfluorocarbon or air), resulting in a rock-hard eye. Changes in intraocular pressure are no longer possible, since the hard eye condition and avascularity persist during enucleation. The vortex veins appear collapsed. Before cutting the optic nerve and vessels, they are compressed by a broad hemostatic clamp for three minutes and then severed by a blade located in the middle of the clamp. With the hypertensive gas technique there is neither bleeding of vortex veins nor of proximal end of stump, which continues to be compressed by the hemostatic clamp. Fifteen patients with choroidal melanomas were enrolled in a prospective study with the hypertensive gas technique from 9/1987 to 6/1989; prior radiotherapy was not performed. Average base diameter of melanoma measured 13.2 mm, height 8.4 mm. Cytology was: 11x spindle, 3x mixed, 1x epitheloid cells. At reexamination in 7/1991 (average follow-up 2.75 years), 2 diabetics had died with no detectable metastases, and 1 of the 15 melanoma patients (6.7%) had died with metastases 2 years after enucleation. The hypertensive gas technique does not postpone enucleation of a melanoma eye while presumed prophylaxis is administered, does not require additional instruments, and takes only a minute when the eye is already draped for surgery. The firm and avascular globe facilities a faster removal of the melanoma eye with practically no bleeding from the bulb.