INTERNAL RESECTION OF POSTERIOR UVEAL MELANOMAS

Aims-To evaluate the safety and efficacy of internal resection in the treatment of malignant melanoma of the choroid. Methods-32 consecutive patients with histopathologically proved malignant choroidal melanoma s were treated with internal resection. 29 of the 32 (90.6%) tumours w ere within 2 disc diameters of the optic nerve or fovea. The surgery w as performed at two university centres by one of the authors. Follow u p was between 1 and 85 months (mean 40.1 months). Results-Three patien ts developed distant metastases and died of malignant melanoma (metast atic and mortality rate 9.4%). In one case, distant metastases develop ed in association with an intraocular recurrence. There have been no o ther intraocular recurrences. The most common postoperative complicati on was vitreous haemorrhage, which occurred in 12 patients (37.5%); ca taract occurred in eight eyes; and three patients developed retinal de tachment postoperatively. Three of the operated eyes have been enuclea ted (9.4%); a total of four (12.5%) have lost light perception. 10 pat ients (31.2%) had visual acuities of 6/60 or better and 18 of 32 (56.3 %) were between 6/120 and light perception. Conclusion-These data sugg est that the internal resection of posterior uveal melanomas is a reas onable globe saving management option. This treatment modality is part icularly well suited to elevated tumours in close proximity to the opt ic nerve or fovea.