To report on trans-scleral local resection of choroidal melanoma as treatment for serous retinal detachment after proton beam radiotherapy (PBR)Methods
Retrospective study of patients underwent trans-scleral local resection of choroidal melanoma after previous PBR from 2000 to 2008 to the Liverpool Ocular Oncology Service.Results
The 11 patients (5 female, 6 male) had a median age of 48.8 years (range 20 – 76) included in this study. The tumor margins extended anterior to ora serrata in 6 patients. On echography, the largest basal tumor dimension averaged 11.9 mm (range 5.7 – 13.2) and the tumor height averaged 7 mm (range 4.5 – 9.9). The retinal detachment was total in 4 cases. Neovascular glaucoma was present in 4 patients. The time between proton beam radiotherapy and local resection had a mean of 17.4 months (range 1 – 84). The follow-up time after the local resection procedure had a mean of 96 months (range 60 – 156). At the last known status, the eye was conserved in 9 patients, with a flat retina in all of these patients and visual acuity better than 6/30 in 5 patients. The reasons for enucleation were: retinal detachment (1 patient) and phthisis (1 patient.Conclusion
Serous retinal detachment and neovascular glaucoma after proton beam radiotherapy of a choroidal melanoma can both resolve after trans-scleral local resection of the tumor. Our findings indicate that these complications are caused by the persistence of the irradiated tumor within the eye (‘toxic tumor syndrome’).