Uveal Melanoma: Evidence for Efficacy of Therapy

Armin R. Afshar, MD, MBA; Bertil E. Damato, MD, PhD


Int Ophthalmol Clin. 2015;55(1):23-43. 

In This Article

Ocular Conservation

The most important factors predicting enucleation are tumor size and proximity of the optic disc.[58] Much depends on the patient's preferences, which are strongly influenced by age, sex, and visual needs, as well as the counseling provided by the ocular oncologist.

The Kaplan-Meier estimate of secondary enucleation within 5 years of treatment in the 650 COMS patients receiving plaque brachytherapy was 12.5%.[16] Local tumor recurrence and neovascular glaucoma are the main reasons for secondary enucleation.[59,60] Initially, retinal detachment was a common reason for enucleation after eyewall resection, but this problem has diminished, because of improvements in surgical technique resulting in better prevention and treatment of this complication.[61]

Enucleation rates after eye-conserving therapy therefore depend on ocular and systemic factors at the time of treatment, therapeutic modality, ability to treat any iatrogenic morbidity and, not least, the threshold for primary enucleation. Comparisons between centers need to take account of cultural differences, especially in multinational studies, because patients in some societies are more reluctant to undergo enucleation than others.