Primary Transpupillary Thermotherapy of Choroidal Melanocytic Lesions

GÜNDÜZ K., Karslioǧlu M. Z., Köse K.

MIDDLE EAST AFRICAN JOURNAL OF OPHTHALMOLOGY, sa.2, ss.183-188, 2011 (ESCI) identifier identifier identifier

  • Yayın Türü: Makale / Tam Makale
  • Basım Tarihi: 2011
  • Doi Numarası: 10.4103/0974-9233.80711
  • Dergi Adı: MIDDLE EAST AFRICAN JOURNAL OF OPHTHALMOLOGY
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus
  • Sayfa Sayıları: ss.183-188
  • Anahtar Kelimeler: Branch Retinal Vein Occlusion, Choroidal Melanoma, Choroidal Nevus, Cystoid Macular Edema, Macular Pucker, Neovascular Glaucoma, Pigment Dispersion into the Vitreous Cavity, Retinal Neovascularization, Ruthenium-106 Plaque Radiotherapy, Transpupillary Thermotherapy
  • Ankara Üniversitesi Adresli: Evet

Özet

Purpose : To evaluate the role of primary transpupillary thermotherapy (TTT) in the treatment of choroidal melanocytic lesions. Materials and Methods : Retrospective chart review of 24 patients (24 eyes) with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization. Results : The mean initial tumor basal diameter was 6.6 (3.0-10.0) mm and the mean initial tumor thickness was 3.0 (1.0-5.0) mm. The mean number of TTT sessions was 2.5 (1-6). The mean decrease in tumor thickness was 1.2 mm (from 3.0 to 1.8 mm) at a mean follow-up of 22.7 (range 3-90) months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients (20.8%)], focal cataract [5 patients (20.8%)], iris atrophy [4 patients (16.6%)] and posterior synechia [4 patients (16.6%)]. There was no significant difference in the complication rate with respect to tumor thickness > 3 mm versus tumor thickness %3 mm and juxtapapillary versus nonjuxtapapillary location (Fishers exact test, P > 0.05). Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes (8.3%) were enucleated because of neovascular glaucoma and one eye (4.1%) was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients (87.5%). One patient (4.1%) with extraocular tumor recurrence developed liver metastasis and expired. Conclusions : Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved.