J.ophthalmol.(Ukraine).2019;6:56-62.

http://doi.org/10.31288/oftalmolzh201965662

Received: 15 November 2019; Published: 06 January 2020

Ultrastructural features of choroidal melanomas after 810-nm diode-laser transpupillary thermotherapy delivered using the developed methodology

V.V. Vit, N.I. Molchaniuk, S.I. Poliakova, I.V. Tsukanova

SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine"; Odesa (Ukraine)

E-mail:  inna.sister@gmail.com

Background: An 810-nm diode-laser transpupillary thermotherapy (TTT) is used as monotherapy in the treatment of small choroidal melanomas (CM; measuring ≤ 3-4 mm in prominence). We developed an advanced methodology for performing the TTT, which involves four sessions delivered daily over four consecutive days.

Purpose: To examine ultrastructural features of therapeutic pathomorphosis after TTT delivered using the developed methodology in enucleated eyes with choroidal melanoma in which eye-preserving treatment was not feasible.

Material and Methods: Material for electron microscopy was obtained from enucleated eyes of seven CM patients who had been treated with TTT delivered over one to four sessions. One patient had undergone one, two had undergone two, two had undergone three, and two had undergone four daily TTT sessions before enucleation, with an 810-nm diode laser (Iridis Quantel medical, France) in a continuous mode, and the power was gradually increased from the initial 200 mW to about 1800 mW until the desired endpoint was achieved. Biopsy fragments were fixed in 2.5% glutaraldehyde in phosphate buffer (pH 7.4), post-fixed with 1% osmium tetroxide in phosphate buffer (pH 7.4), dehydrated through an ascending ethanol series, and embedded in an Epon/Araldite mix. Thereafter, ultra-thin sections were cut, stained with lead citrate according to the procedure described by Reynolds, and observed with a PEM-100-01 Transmission Electron Microscope.

Results: In our ultrastructural studies of choroidal melanoma after TTT delivered using the developed methodology, the most pronounced manifestations of therapeutic pathomorphosis were observed at day 4, and the developed methodology was substantiated by the ultrastructural findings. The therapeutic pathomorphosis in the melanoma tissue in response to 810-nm diode laser irradiation manifested itself as dry or wet necrosis, which was partial after the first treatment session, but a complete destruction of tumor cells at a depth of ≤ 4 mm from the irradiated surface was observed after four days of daily sessions. This indicates that our TTT delivery methodology can be used for treatment of small (T1) CM (measuring ≤ 3 mm in prominence and ≤ 12 mm in basal dimension).

Conclusion: In our ultrastructural studies, the most pronounced changes in choroidal melanoma tissue manifested themselves as dry or wet necrosis, and were observed at day 4 of daily sessions of 810-nm diode laser TTT.

Keywords: choroidal melanoma , diode-laser transpupillary thermotherapy,  electron microscopy 

 

References

1.Bulgakova ES. [Treatment of small choroidal melanomas with diode laser transpupillary thermotherapy]. [Abstract of Cand Sc (Med) Thesis]. Moscow: Helmholtz Research Institute for Eye Diseases; 2005. Russian.

2.Linnik LF, Magaramov DA, Iarovoi AA, et al. [Potential of diode laser transpupillary thermotherapy as an organ- and function-preserving treatment option in small choroidal melanomas]. In: [Proceedings of the Jubilee Symposium on Current Issues in Ophthalmology]. Research Institute of Eye Disease: Moscow; 2003. p.86-7. Russian.

3.Linnik LF, Magaramov DA, Iarovoi AA, Semikova TS. [Diode laser transpupillary thermotherapy: the potential for the treatment of small choroidal melanomas]. Ophthalmokhirurgiia. 2002;(3):45–50. Russian.

4.Iarovoi AA, Linnik LF, Magaramov DA, et al. [Diode laser transpupillary thermotherapy: the potential for the treatment of small choroidal melanomas]. Russkii meditsinskii zhurnal. 2004;5(2):77–81. Russian.

5.Linnik LF, Magaramov DA, Iarovoi AA, et al. [Three year experience of using diode laser transpupillary thermotherapy as a monotherapy for the management of uveal melanoma]. Ophthalmokhirurgiia. 2003;(4):17–24. Russian.

6.Iarovoi AA, Linnik LF, Semikova TS, Bulgakova ES. [Small choroidal melanomas: clinical picture and selecting the appropriate treatment option]. Novoiie v ophthalmologii. 2004;(2):28–37. Russian.

7.Aaberg TM Jr, Bergstrom CS, Hickner ZJ. Long term results of primary transpupillary thermal therapy for the treatment of choroidal malignant melanoma. Br J Ophthalmol. 2008 Jun;92(6):741-6. 

Crossref   PubMed

8.De Potter P, Levecq L. [Transpupillary thermotherapy in the treatment of choroid melanoma]. J Fr Ophtalmology. 2001 Nov;24(9):937-43. French.

9.De Potter P. [Choroidal melanoma: current therapeutic approaches]. J Fr Ophtalmology. 2002 Feb;25(2):203-11. French.

10.Duquesne N, Hajji Z, Jean-Louis B, Grange JD. [Choroidal nevi associated with serous macular detachment].  J Fr Ophthalmol. 2002 Apr;25(4):393-8. French.

11.Forte R, Cennamo G. [Transpupillary thermotherapy of choroidal melanomas]. J Fr Ophtalmol. 2008 Mar;31(3):279-81. French.

12.Godfrey DG, Waldron RG, Capone A Jr. Transpupillary thermotherapy for small choroidal melanoma. Am J Ophthalmol. 1999 Jul;128(1):88-93.

Crossref  

13.Pan Y, Diddie K, Lim JI. Primary Transpupillary Thermotherapy for Small Choroidal Melanomas. Br J Ophthalmol. 2008 Jun;92(6):747-50.

Crossref  PubMed  

14.Chojniak MM, Chojniak R, Nishimoto IN, Allemann N, Erwenne CM. Primary transpupillary thermotherapy for small choroidal melanoma. Graefes Arch Clin Exp Ophthalmol. 2011 Dec;249(12):1859-65. 

Crossref   PubMed  

15.Shields CL, Shields JA, Peres N, et al. Primary transpupillary thermotherapy for small choroidal melanoma in 256 consecutive cases: outcomes and limitations. Ophthalmology. 2002 Feb;109(2):225-34.

Crossref  

16.Primavera V, Russo V, Laculli C, Delle Noci N. Transpupillary thermotherapy for small choroidal melanoma: results in 25 patients. Xth International congress of ocular oncology: Final program and abstract book. Amsterdam, the Netherlands; 2001. p. 292.

17.Robertson DM, Buettner H, Bennett SR. Transpupillary thermotherapy as primary treatment for small choroidal melanomas. Arch Ophthalmol. 1999 Nov;117(11):1512-9.

Crossref   PubMed

18.Turcotte S, Bergeron D, Rousseau AP, Mouriaux F. Primary transpupillary thermotherapy for choroidal indeterminate melanocytic lesions. Can J Ophthalmol. 2014 Oct;49(5):464-7. 

Crossref   PubMed  

19.Information Bulletin No. 22, p.3, based on Pat. of Ukraine №102,890 issued 25.11.2015. Method for treatment of T1 choroidal melanoma. Authors: Pasyechnikova NV, Naumenko VO, Poliakova SI, Tsukanova IV. Owner: State Institution Filatov Institute of Eye Diseases and Tissue Therapy, NAMS of Ukraine. Ukrainian.

20.Diaz CE, Capone A, Grossniklaus HE. Clinicopathologic findings in recurrent choroidal melanoma after transpupillary thermotherapy. Ophthalmology. 1998 Aug;105(8):1419-24.

Crossref  

21.Наrbour JW, Meredith TA, Thompson PA, Gordon ME. Transpupillary thermotherapy versus plaque radiotherapy for suspected choroidal melanomas. Ophthalmology. 2003 Nov;110(11):2207-15.

Crossref  

22.Journee-de Korver JG, Oosterhuis JA,  Kakebeeke-Kemme HM,  Wolff-Rouendaal D.  Transpupillary thermotherapy (TTT) by infrared irradiation of choroidal melanoma. Doc Ophthalmol. 1992;82(3):185-91.

Crossref    PubMed  

23.Singh AD, Eagle RC Jr, Shields CL, Shields JA. Clinicopathologic reports, case reports, and small case series: enucleation following transpupillary thermotherapy of choroidal melanoma: clinicopathologic correlations. Arch Ophthalmol. 2003 Mar;121(3):397-400.

Crossref  PubMed  

24.Shields CL, Shields JA, DePotter P, Kheterpal S. Transpupillary thermotherapy in the management of choroidal melanoma.  Ophthalmology. 1996 Oct;103(10):1642-50.

Crossref   

25.Shields CL, Shields JA, Cater J, et al. Transpupillary thermotherapy choroidal melanoma: tumor control and visual results in 100 consecutive cases. Ophthalmology. 1998 Apr;105(4):581-90.

Crossref  

26.Langmann G, Kleinert R, Faulbom J, et al. [Transpupillary diode laser hyperthermia histopathology findings of eyes with melanoma and first clinical results]. Abstract. Retinologische Gesellschaft, Munchen, Germany. June, 1996.

 

The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.