Transpupillary thermotherapy for small choroidal melanoma

PURPOSE: To report the treatment of small choroidal melanoma with transpupi llary thermotherapy, METHODS: We examined a nonrandomized and uncontrolled series of 14 eyes of 14 patients who were followed up with serial ophthalmoscopy, ultrasonograph y, and photography. Transpupillary thermotherapy was per formed upon docume nted evidence of tumor growth, RESULTS: After transpupillary thermotherapy, mean follow-up +/- SD was 16 /- 6.41 months (range, 7 to 28 months) with 10 eyes followed up for at leas t. 1 year. The mean preoperative tumor height was 1.79 +/- 0.59 mm (range, 0.78 to 2.60 mm). Six months after treatment, the mean height was 0.54 mm /- 0.51 mm (range, 0.00 to 1,16 mm),ln 10 eyes, the treated lesion Battened entirely with a mean interval between treatment and Battening of 8.7 month s (range, 3 to 21 months), Three patients required retreatment for lack of regression or recurrent growth. The average time to retreatment was 11 mont hs (range, 5 to 15 months). No eye was retreated more than once. There were three amelanotic lesions, all treated in a single session without recurren ce, Complications consisted of retinal hemorrhage, retinal vascular occlusi on, retinal traction, exudative serous neurosensory detachment, vitreitis, and postoperative pain, The sole treatment failure occurred in an eye treat ed with a juxtapapillary tumor, with recurrence developing from a previousl y Battened lesion, This eye was enucleated 10 months after the single initi al treatment, Ar the time of writing, there had been no tumor-related death , CONCLUSIONS: Transpupillary thermotherapy may represent a viable treatment alternative for both pigmented and amelanotic small choroidal melanoma, Dil igent follow-up is axiomatic because retreatment may be necessary. Recurren t tumors may develop from Bat lesions. Juxtapapillary tumors may be at high er risk for recurrence. Definitive statements regarding the role of transpu pillary thermotherapy in the management of small choroidal melanoma await 5 -year and 10 year morbidity and mortality data, (Am J Ophthalmol 1999;128: 88-93, (C) 1999 by Elsevier Science Inc. All rights reserved.)