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Y. Pan, K. Diddie, J. I. Lim; Primary Transpupillary Thermotherapy for Small Choroidal Melanomas. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5257.
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Recent studies have highlighted concerns about using transpupillary thermotherapy as primary treatment for small malignant choroidal melanomas due to higher than previously believed rate of recurrences and complications. We sought to determine long term visual and anatomic outcomes following TTT for small melanomas.
We retrospectively reviewed 20 patients with small choroidal melanomas who underwent primary TTT at our institution between 1996 and 2005. Patients with small choroidal melanoma posterior to the equator with basal diameter less than 12 mm and thickness less than 4 mm were included. In addition, lesions either had documented growth or clinical risk factors for growth.
Thirteen women and seven men with a mean age of 65 (range: 41-85 years) underwent TTT. The mean preoperative tumor thickness was 1.8 mm (range: 0.78 -3.4 mm). Mean follow up time after TTT treatment was 43.9 months (range: 11- 108 months, median: 45 months). Nineteen tumors showed either photographic or ultrasound documentation of growth; one tumor had risk factors for growth. After a mean number of 2.15 primary TTT sessions (range: 1-4), tumor regression without recurrence was attained in 10 out of the 20 cases (50%). Six of the 10 tumors with recurrence were successfully treated with additional TTT. One case proceeded to enucleation without repeat TTT because the patient declined further treatments. Three other cases had reoccurrence after repeat TTT and required alternative treatments such as cryotherapy, plaque radiotherapy, or enucleation. The mean time to primary recurrence after initial TTT was 20.6 months (range: 8-37 months). The mean time to recurrence after repeat TTT was 35 months (range 5-69 months). There was no tumor related metastasis or death. Visual acuity at 11-13 months after primary TTT was 20/20 to 20/40 in 13 cases, 20/50 to 20/100 in 5 cases, and 20/200 or worse in 2 cases. The final visual acuity after treatment was 20/20 to 20/40 in 14 cases, 20/50 to 20/100 in 4 cases, and 20/200 or worse in 2 cases. Retinal hemorrhage was the most common complication and occurred in 6 cases (30%). Other complications included vitreous hemorrhage (1), BRAO (1), tractional retinal detachment (1), and serous retinal detachment (1).
Tumors treated with transpupillary thermotherapy have significant recurrence rates. Although tumor control may ultimately be achieved with TTT, close monitoring of these tumors are necessary as repeat TTT and/or alternative therapies may be required.
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