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P. Valente, M. A. Blasi, A. Scupola, G. Savino, E. Midena, A. C. Tiberti, E. Balestrazzi; Photodynamic Therapy for Amelanotic Choroidal Melanoma Unresponsive to Standard Treatment Modalities. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3372.
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© ARVO (1962-2015); The Authors (2016-present)
Brachytherapy is the most widely used treatment for choroidal melanoma often combined with transpupillary thermotherapy (TTT). The combination of plaque radiotherapy with TTT provides excellent intraocular tumor control with local tumor recurrence of only 3% at 5 years follow-up. Amelanotic melanoma is a tumor responding less to brachytherapy and TTT than darker tumors. The aim of this study is to investigate the effect of photodynamic therapy with verteporfin on amelanotic choroidal melanoma that showed recurence or no response after previous brachytherapy and TTT.
an interventional case-series of the effects of PDT was performed in 4 patients with choroidal amelanotic melanoma. PDT was considered as last therapeutic option, before enucleation. PDT was performed using 6 mg/m2 body surface area of verteporfin administered intravenously. The light dose used was 100 J/cm2 at 689 nm, 15 minutes after injection. Biomicroscopy, ultrasound, fluorescein/indocyanine green angiography (FA, ICGA), optical coherence tomography (OCT) were evaluated before treatment and 2 weeks, 1, 3, and every 4 months after treatment.
following treatment, all tumours decreased in size (mean height pre-treatment 4.53 mm; post-treatment 2.1 mm). All patients showed an improvement in visual acuity. Two patients experienced a transient subretinal haemorrhage. Angiographic features showed ipofluorescence in the treated area due to closure of the tumour vessels. OCT detected a resolution of subretinal and intraretinal fluid with atrophic changes of the retina.
PDT can become an adjuvant treatment method for amelanotic uveal melanoma. Vascular occlusion and thrombosis in tumor vessel were observed in eyes treated with PDT. Melanin may reduce the photo-oxidative effects of PDT. The high vascular density and the absence of melanina in amelanotic melanoma could explain the efficacy of PDT. Careful long-term follow-up must be performed to determine whether PDT can play a role as supplementary modality in the treatment of choroidal melanoma.
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