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Andre Aexis Coazza Vidoris, Andre Maia, Rubens Belfort, Jr., Marcia Lowen, Bruno Fernandes, Rafaello Salas, Marcio Costa; Endoresection Surgery for Intra Ocular Choroidal Tumors. Short Term Results. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5096.
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Internal eyewall resection or endoressection has been proposed as an alternative therapy to irradiation by Peyman et al. and Damato et al. Endoressection is a surgical technique where the tumor is excised by a vitreous cutter during pars plana vitrectomy, which provides direct access to posterior tumors. This study aims to evaluate the endoressection technique in the treatment of choroidal melanoma.
Thirteen patients with choroidal melanoma, diagnosed by indirect ophthalmoscopy, ocular ultrasonography, and fundus photography were selected for this study. None of the patients showed evidence of metastasis on systemic screening. The same surgeon performed all surgical procedures. Patients were evaluated by best-corrected visual acuity (EDTVRS chart), slit lamp microscopy (including the sclerotomy sites), indirect ophthalmoscopy, retinography, and ocular-ultrasonography at the inclusion. Each patient was seen at baseline, d30, d60, d90, and in 3-month intervals afterwards for at least 6 months. The systemic-workup (liver tests, abdominal ultrasonography, chest X-ray) was done every 3 months starting for at least 6 months. The vitreous aspirate from every case was sent to histopathological evaluation. The fluid was centrifuged and fixed in formaline, and embedded in paraffin. A trained ocular pathologist evaluated the Hematoxilin-eosin stained slides by light microscopy.
Thirteen patients, including eight (08) woman’s (61,5%%) and one male (38,5%) were included in the study. The age ranged from 42 to 65 years old, the mean age was 50,25. The tumor size by ultrasonography measures ranged from 3.3 to 9.7 millimeters in high, the mean high was 6.03 millimeters. In all cases the pathologist was able to make a histological diagnose. The eye retention rate was 100% in twelve months. In a twelve-month follow up, one patient developed liver metastasis.
Endoresection could be a safe and eye-sparring treatment for patients with medium to large choroidal melanoma. Every globe was saved and no recurrences were detected. Moreover, the material obtained during the surgical procedure was able to yield an accurate pathological diagnosis in all patients. Our pilot study confirms the usefulness of this therapeutic modality for local control of the disease. Larger series and longer follow-up periods will determine whether the natural history of the disease is affected.
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