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Caesar Luo, Antonio Capone, Jr., Lisa Faia, Melanie Schmitt; Long Term Results of Primary Transpupillary Thermotherapy in Choroidal Melanoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3277.
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Evaluate long-term results of transpupillary thermotherapy (TTT) as primary therapy for choroidal melanoma in one institution.
Retrospective case series of patients demonstrating small choroidal melanoma treated with TTT as primary therapy. Outcomes included patient demographics, tumor characteristics, treatment effectiveness, visual acuity over time, recurrence, mortality, and complications.
26 patients with a minimum of 12-month and a mean of 51-month followup were reviewed. 15 women and 11 men with an average age of 63.6 years were included. 23 of 26 patients (88.4%) demonstrated regression of tumor without recurrence. Of the tumors with recurrence, all achieved resolution to flat lesion with repeat TTT alone. The mean time to flat lesion by ultrasound was 5.9 months. Average number of TTT sessions in regressed tumors was 2.2. At last followup, mean visual acuity was 0.42 logMAR, or 20/50 Snellen. Of the tumors that demonstrated recurrence, mean time to recurrence was 30.3 months, with a mean initial tumor thickness of 2.06 mm. All recurrent tumors demonstrated high risk characteristics prior to initial TTT including subretinal fluid, orange pigment, and symptoms. No recurrent tumors displayed pretreatment vascularity. 6 patients (23%) developed TTT related complications, including epiretinal membrane (3), vitreous hemorrhage (2), and transient vitritis (1).
Primary transpupillary thermotherapy is an effective alternative to plaque brachytheraphy for choroidal melanoma in select cases. Our series demonstrates that long term success is achievable with judicious patient selection and close patient followup. Accessibility to office based care and avoidance of secondary radiation sequelae are important considerations.
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