Vitreoretinal surgery and endoresection in high posterior choroidal melanomas

Purpose: Eyes with posterior choroidal melanomas more than 9 mm in thicknes s frequently are enucleated because of the potential complications of radio therapy. The aim of this study was to evaluate the safety and efficacy of i nternal resection of these tumors. Methods: Twenty-five consecutive patients with high posterior choroidal mel anomas with a diameter less than 15 mm and a thickness greater than 9 mm we re treated. If the retina was not invaded by the tumor, a vitrectomy was pe rformed, followed by posterior hyaloid dissection, 120 degrees anterior ret inotomy, endophotocoagulation 2 mm past the tumor margin, melanoma removal with the vitrectomy probe, retina] reattachment with liquid perfluorocarbon and air, and silicone oil exchange. If the tumor invaded the retina, the l aser was applied through the retina, and the retina and tumor were removed together. Results: The mean patient age was 46.6 years. The tumor thicknesses ranged from 9.1 to 12.8 mm, and the tumor diameter ranged from 8.9 to 14.8 mm. The mean preoperative visual acuity was 20/60. In 11 patients, the tumor had i nvaded the retina. We removed the entire tumor from all 25 eyes. The main p ostoperative complications were cataract (40%), retinal detachment (16%), m acular traction (16%), and epiretinal macular proliferation (8%). The mean postoperative visual acuity was 20/100. No tumors recurred, and there was n o evidence of metastasis. The follow-up ranged from 12 to 72 months. Conclusions: These data suggest that internal resection of high posterior m elanomas may conserve ocular and functional vision and does not seem to inc rease the risk of metastatic disease. Longer follow-up is necessary to esta blish the safety of the procedure.