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.