Surgical Management of Posterior Uveal Melanoma

Trends and Developments

Samuel K Houston; Marcela Ardila-Lonngi; Arnold M Markoe; Timothy G Murray

Disclosures

Expert Rev Ophthalmol. 2013;8(4):393-399. 

In This Article

Abstract and Introduction

Abstract

Uveal melanoma is the most common primary malignancy of the eye in adults and affects approximately four people per million in the USA each year. Historically, patients were treated with enucleation, but results of the Collaborative Ocular Melanoma Study paved the way for globe-salvaging treatment. With plaque brachytherapy and proton beam irradiation having similar outcomes as enucleation in medium tumors, a new set of problems surfaced. Radiation-related complications caused severe visual morbidity in the majority of patients, with some progressing to neovascular glaucoma and requiring enucleation. To combat these issues, varying surgical managements have emerged as primary treatments for uveal melanomas as well as to treat radiation-related complications. We anticipate further advancements and studies regarding these surgical techniques, as well as a better understanding of the gene expression profiling of these tumors and their propensity for metastasis.

Introduction

Over the past few decades, vitreoretinal surgery has undergone significant advancements in surgical technique and instrumentation. Progressively smaller instrumentation, from 20 gauge to 23 and 25 gauge, offer a wide variety to the surgeon. Smaller instrumentation offers some benefits, including potential for sutureless surgery and smaller sclerotomies that may hasten surgical and visual recovery. The realm of conditions treated with vitrectomy includes vitreous hemorrhage, vitreoretinal interface disorders such as macular holes and epiretinal membranes, retinal detachments and even as a diagnostic tool for culture or retina/choroidal biopsy. Uveal melanoma is the most common primary eye cancer in adults and often leads to visual changes because of a posterior location. With the adoption of globe-salvaging treatments for uveal melanoma, opportunities have arisen for surgical management of visually significant disease. The current review article will discuss the surgical management of posterior uveal melanoma.

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