Current conservative management strategies for uveal melanoma

Primary malignant intraocular tumors are rare. Of these, malignant melanoma s represent about 75%; 20% are retinoblastomas and 5% are primary intraocul ar lymphomas. In the management of patients with malignant melanoma of the ciliary body and choroid (posterior uvea), treatment techniques have includ ed not only surgery (enucleation and orbital exenteration in very advanced cases) but also photocoagulation, local resection, and cryotherapy. Since t he introduction of radioactive plaque therapy about 35 years ago, this type of bulb-conserving procedure has become very popular and today is the most favored treatment in certain stages of malignant uveal melanoma. Other rad iooncological methods like proton beam or helium ions have also proven to b e effective in these ocular malignancies but can only be performed in selec ted places in few countries. Thermoradiation is still experimental and has to prove its routine clinical use and effectiveness. Because of promising r esults, local resection in combination with adjunctive radioactive plaque t herapy probably seems to be used more often in the future. The primary goal of treatment is not only conservation of the eye with acceptable vision, b ut also to gain the same prognosis as with enucleation. Despite many reliab le treatment results, authorities still disagree whether enucleation or con servative treatment offers the best prognosis, although many retrospective studies have suggested that the method of treatment makes no difference in the systemic prognosis.