TRANSPUPILLARY THERMOTHERAPY IN THE MANAGEMENT OF CHOROIDAL MELANOMA

Background: Several methods of treatment have been used for choroidal melanoma. The purpose of this report is to evaluate the effectiveness of transpupillary thermotherapy using near-infrared radiation to treat choroidal melanoma. Methods: A prospective study was conducted to eva luate the clinical features, treatment results, and complications of p atients with choroidal melanoma who were treated with transpupillary t hermotherapy delivered over one to four sessions and followed for at l east a 6-month period. All treated tumors had either documentation of growth or ophthalmoscopic risk factors for future growth and/or metast asis. Results: There were 17 patients with choroidal melanoma treated with transpupillary thermotherapy, The mean tumor size before treatmen t was 6.6 mm in base and 3,0 mm in thickness. The tumor margin was a m ean of 2.3 mm from the optic disc and 2.7 mm from the foveola. Seven t umors (41%) touched the optic disc margin and three (18%) were under t he fovea. The tumor responded to treatment in all patients, with a dec rease in thickness and resolution of associated subretinal fluid, At a minimum of 6 months of follow-up, the mean tumor thickness was 1.7 mm , and the tumor site was a residual chorioretinal scar with partial vi sibility of the sclera in all patients. Despite the proximity to the o ptic disc and foveola, the final visual acuity was the same or improve d in ten eyes (59%) and decreased in seven (41%). The improved vision was due to resolution of subfoveal fluid, whereas the decreased vision was primarily the result of treatment in the fovea with ultimate reti nal vascular occlusion or preretinal traction, Although longterm follo w-up is not yet available, there were no patients with tumor recurrenc e or tumor metastases. Conclusion: This preliminary study demonstrates that transpupillary thermotherapy appears to be an effective treatmen t For selected small choroidal melanomas and may be a particularly use ful modality for treating those tumors near the foveola and optic disc . Longer follow-up is necessary to assess for local recurrence and the impact of treatment on survival.