Endoresection of choroidal melanoma using high-frequency electric welding of biological tissues
N.N. Umanets, Cand Sc (Med)
N.V. Pasyechnikova, Dr Sc (Med), Prof.
V.A. Naumenko, Dr Sc (Med), Prof.
A.P. Maletskyi, Dr Sc (Med)
E.P. Chabotarev, Cand Sc (Med)
Filatov Institute of Eye Diseases and Tissue Therapy, NAMS of Ukraine
Background: The evolution of ocular oncology over the recent decades has been characterized by the emphasis on organ saving approaches, the main method requirement being the greatest degree of radicalism of tumor resection with a minimum amount of damage to surrounding tissues.
Purpose: To assess the efficacy of endoresection for uveal melanoma, with the high-frequency electric welding used for achievement of hemostasis.
Materials and Methods: Twenty patients (21 eyes; age, 51.6 (12.43) years) with choroidal melanoma were under our observation during 2010 to 2014. Prior to any treatment, the maximum tumor thickness based on ultrasound examination (Cine Scan) was 5.4 (2.6) mm (range, 1.4 mm to 10 mm), with the mean largest basal tumor diameter of 10.8 (3.7) mm (range, 7.6 mm to 15.8 mm). Patients underwent strontium-90 brachytherapy plus transpupillary thermotherapy to devitalize the tumor. Two months to 3 years thereafter, they underwent a 20-G three-port vitrectomy during which endoresection of melanoma was performed.
Results: In 19 eyes (90%), massive hemorrhage from uveal melanoma vessles and choroidal vessels was observed during excision of tumor tissue, and was successfully resolved with high-frequency electric welding using a unipolar endovitreal probe. All patients were still alive at the end of observation period of 2 to 6 years. Two of them underwent enucleation due to progressive tumor growth and due to subacute uveitis and phthisis bulbi, respectively.
Conclusions: Endoresection is an alternative technique for the treatment of uveal melanoma, with the eye salvage rate as high as 90%. The use of high-frequency electric welding of biological tissues in endoresection of uveal melanoma allowed us to avoid choroidal and ciliary hemorrhage in all cases, thus reducing the risk of intra- and post-operative complication.
1.Anina IeI, Levtiukh VI. [Ophthalmological care for the population of Ukraine]. In: [Proceedings of the XII symposium on Surgical and Medication-induced Restoration of Vision]. 2001 June 29-July 1; Chernivtsi; 2001. p.8 Ukrainian
2.Brovkina AF. [Current aspects of management of choroidal melanoma: issues and questions to discuss]. Vestn Oftalmol. 2006;1:13–5 Russian
3.Brovkina AF. [Current aspects of management of uveal melanoma]. Vestn Oftalmol. 1998;3:3–5. Russian
4.Panova IE, Bukhtiiarova NV, Efimenko IN. [Transpupillary thermotherapy in organ-saving management of uveal melanoma]. Ocular Surgery & Therapy. 2004;4(3):32–6. Russian
5.Bechrakis NE, Blatsios G, Schmid E, et al. Surgical resection techniques of large uveal melanomas. Spektrum Augenheilkd. 2010;24:17–22
10.Boiko EV, Shishkin MM, Yan AV. [Transsleral thermotherapy in the management of choroidal melanoma]. In: [Proceedings of the Symposium on Ocular Tumors and Tumor-like Disorders]. 2007 November 27-29; Moscow; 2007. p.31–5 Russian
11.Song WK, Yang WI, Byeon SH, et al.Clinicopathologic report of uveal melanoma with persistent exudative retinal detachment after gamma knife radiosurgery. Ophthalmologica. 2010;224(1):16–21
12.Conway RM, Poothullil AM, Daftari IK, et al. Estimates of ocular and visual retention following treatment of extra-large uveal melanomas by proton beam radiotherapy. Arch Ophthalmol. 2006;124:838–43
13.Egan K, Ryan L, Gragoudas E. Survival implications of enucleation after definitive radiotherapy for choroidal melanoma. Arch Ophthalmol. 1998 Mar;116(3):366–70
14.Peyman GA, Cohen SB. Ab interno resection of uveal melanoma. Int Ophthalmol. 1986 Apr;9(1):29–36
15.Schmidt JC, Brieden-Azvedo S, Nietgen GW. [Therapy of radiation resistant malignant uveal melanoma with endoresection by pars plana vitrectomy in two patients]. Klin Monbl Augenheilkd. 2001 Dec;218(12):800–4 German
16.Damato B, Groenewald C, McGalliard J, et al. Endoresection of choroidal melanoma. Br J Ophthalmol. 1998 Mar; 82(3):213–8
17.Bechrakis NE, Höcht S, Martus P, et al. [Endoresection following proton beam irradiation of large uveal melanomas]. Ophthalmologe. 2004 Apr;101(4):370–6
18.Bechrakis NE, Foerster MH. Neoadjuvant proton beam radiotherapy combined with subsequent endoresection of choroidal melanomas. Int Ophthalmol Clin. 2006 Winter;46(1):95–107
19.Foster WJ, Harbour JW, Holekamp NM, et al. Pars plana vitrectomy in eyes containing a treated posterior uveal melanoma. Am J Ophthalmol. 2003 Sep;136(3):471–6
20.García-Arumí J, Sararols L, Martinez V, et al. Vitreoretinal surgery and endoresection in high posterior choroidal melanomas. Retina. 2001;21(5):445–52
21.Brovkina AF, Saakian SV. Visual acuity after block excision of tumors of the anterior uvea with and without restoration of the round shape of the pupil. In: Proceedings of the XI Congress of the European Society of Ophthalmology. 1997 June 1-5; Budapest; p. 1602