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Ira Seibel, Dino Cordini, Gregor Willerding-Beaucamp, Jens Heufelder, Antonia Joussen; Minimally invasive therapy of exudative retinal detachment (ERD) due to choroidal or ciliary body melanoma after irradiation therapy compared to endoresection. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4243. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Choroidal melanoma is often accompanied by an ERD. This retrospective study investigates if minimally invasive surgery consisting of vitrectomy with endodrainage,-photocoagulation and silicone oil filling leads to permanent reattachment and if there are differences in visual outcome, tumor control or retinal attachment compared to endoresection.
28 patients who presented with a persistent ERD due to choroidal (n=23) or ciliary body (n=5) melanoma between 2003 and 2011 were included. After irradiation vitrectomy was performed. As comparison group we identified 183 patients (174 with choroidal melanomas and 9 with ciliary body melanomas) with a persistent ERD who delivered secondary endoresection between 2003 and 2011.
Endodrainage- group: Mean follow-up was 27.3 months (4.2-95.1). At follow-up retina was attached in 25 patients (90%). Mean visual acuity (VA) before irradiation was 0.5 logMar (20/60 sn) and 0.8 (20/120) at time of follow-up. Initial tumor thickness was 6.49 mm (1.91-10.2; ± 2.17) and was reduced to 3.45 (1.18-5.66; ± 1.28) at follow-up. No patient showed local recurrence. Metastasis appeared in 2 patients. Endoresection-group: Mean follow-up was 45.4 months (2.8 -123.5). At follow-up retina was attached in 171 (93%) patients. Initial VA was 0.35 logMar (20/45), VA in follow-up was 1.0 (20/200). Local recurrence was found in 5 (2.7%) patients. Metastasis occurred in 38 patients. Retinal reattachment was equally successful in both groups. Both had a significant visual impairment and a decrease of tumor thickness in follow-up. Patients with endoresection showed more frequent radiation retinopathy, radiation optical neuropathy and cataract than patients of the other group. These complications mentioned above depended on time of follow-up. Due to differing time of follow-up these results must be considered critically. Related to local or systemic tumor control there was no significant difference between both groups.
The minimally invasive method for ERD is a successful treatment with an equal outcome compared to endoresection. We recommend this treatment modality in patients with expected systemic and ocular complications (large LTD, cardiovascular disease, hypertension, diabetes, anticoagulation therapy). Sufficient local anti-inflammatory therapy is relevant during follow-up.
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