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Yi Jiang, Rebecca Deutsch, Jack A Cohen; Efficacy and Safety of Transpupillary Thermotherapy for Small Choroidal Melanomas.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5084.
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To investigate the efficacy and the complications of transpupillary thermotherapy on small sized choroidal melanomas and nevomas used as primary treatment.
We retrospectively reviewed all patients seen from January 2000 to September 2013 that received transpupillary thermotherapy for small choridal melanomas or nevomas. We limited the inclusion size of the melanomas to 4 millimeters in thickness. We also excluded any patient that had received other treatments prior to receiving transpupillary thermotherapy.
There were 34 eyes from 34 patients. 17 (50.0%) patients were male and 17 (50.0%) were female. The mean age was 58.3 years (23-89). The mean follow up time was 60.8 months (4-149). Average tumor thickness was 2.89mm (1.1-4.0). Of all patients, 18 (52.9%) patients ultimately achieved local tumor control with transpupillary thermotherapy alone while 16 (47.1%) patients had to undergo other treatments to control their melanoma. 6 patients (37.5%) ultimately had enucleations, 7 patients (43.8%) underwent brachytherapy, 2 patients (12.5%) had photodynamic therapy, and 2 patients (12.5%) had proton beam radiation therapy. Of the 18 patients which were controlled with transpupillary thermotherapy, 10 patients (55.6%) had good control with one treatment session. 8 patients ultimately had more than one treatment session - 6 patients had two sessions (33.3%), 1 patient (5.6%) had 3 treatments sessions, and 1 patient (5.6%) had 7 treatment sessions. Of the 34 total patients, 17 (50.0%) had control without recurrence while 15 patients (44.1%) had at least one recurrence and 2 patients (5.9%) had primary treatment failure. In total, 59 sessions of transpupillary thermotherapy performed and there were 10 reported complications - 5 incidences (8.5%) of vitreous hemorrhage, 2 incidences (3.4%) of retinal striae formation, 1 (1.7%) branch retinal vein occlusion, 1 (1.7%) subretinal hemorrhage, and 1(1.7%) rhegmatogenous retinal detachment.
Transpupillary thermotherapy has a good safety profile with a low complication rate and can be employed when brachytherapy, proton beam therapy, or enucleation is not desired. The treatment is limited, however, by the significant recurrence rate and need for repeat treatments.
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