Uveal tumour resection

Aim-To review the ocular retention rates, visual results, and metastases in uveal tumours managed with eye wall resection techniques. Methods-This was a retrospective analysis of consecutive local uveal tumour resections performed by a single surgeon. All enucleation specimens were r eviewed by one author. Both parametric and non-parametric analysis of data were performed. Results-138 eyes were scheduled for eye wall resection surgery. The mean ag e was 52 years (range 11-86 years). Tumours involved predominantly the iris in 14 cases, iris-ciliary body in 57, ciliary body alone in 18 patients, a nd in 49 cases the choroid was involved (ciliochoroidal, iris-ciliary body- choroid, or choroid). 125 eyes harboured melanomas; posterior tumours were more likely to have epithelioid cells (p <0.05). The mean follow up was 6 y ears. The mean clock hours in iris and iris-ciliary body tumours was 3.5. I n tumours that involved the choroid the mean largest diameter was 12.9 mm a nd the mean thickness 8.5 mm. 105 of 138 (76%) eyes were retained. Histolog ical assessment of surgical margins did not correlate evidence of tumour in enucleated eyes or metastatic disease. Surgical margins of more anterior t umours were more likely to be clear on histological evaluation (p<0.05). Ap proximately 53% of retained eyes had a final visual acuity of <greater than or equal to>20/40; visual results were significantly better in more anteri orly located tumours (p<0.05). All retained iris tumour cases had <greater than or equal to>20/40 final visual acuity. In tumours that involved the ch oroid nine of 31 retained eyes kept that level of visual acuity. Eight pati ents developed metastases; all metastatic events developed in patients with tumours that involved the choroid, and seven of eight were mixed cell mela nomas. Conclusions-76% of eyes were retained and 53% of these had a final visual a cuity of greater than or equal to 20/40. Only 7% of uveal melanoma patients developed metastatic disease with a mean follow up of 6 years. Survival di d not appear to be compromised with eye wall resection and in very thick, m ore posterior melanomas it appeared that ocular retention and visual result s were better than with radiation alone.