97th DOG Annual Meeting 1999
PRIMARY TRANSPUPILLARY THERMOTHERAPY ( TTT ) FOR MALIGNANT CHOROIDAL MELANOMAS
B. M. Stoffelns , A. J. Augustin , N. Pfeiffer
Background: Transpupillary thermotherapy as a new treatment for choroidal melanomas is usually employed as a supplement to plaque radiotherapy.
Patients and methods: In a prospective nonrandomized analysis 20 patients suffering from choroidal melanoma were treated with TTT alone. Primary melanomas posterior to the equator with base < 12 and thickness < 4,5 mm, with documented growth or risk factors for growth or metastasis were included in this study. TTT was performed using a diode laser (810 nm) until the retinal surface became gray - white ( beam diameter 3 mm, power setting 0,3 - 0,7 Watt, exposure time 15 - 65 minutes ). Follow - up examinations were performed at 4 - week intervals. Clinical aspect , ultrasonographic tumor thickness, fluorescein angiography, visual acuity and side effects were recordet.
Results:In 10 eyes tumor was flattened to a chorioretinal scar within 3 months. In 5 eyes TTT was repeated. During the follow - up period of 6 months 15 eyes gained a flat chorioretinal scar, 2 eyes showed a residual prominence of 1,5 mm without tumor vessels in fluorescein angiography. 3 amelanotic melanomas showed no reponse to TTT even of repeated treatment at higher energy levels. Despite the tumor location near optic disc and fovea visual acuity remained unchanged or improved in 12 eyes. The improved vision was due to resolution of subretinal fluid. Ocular side effect in only one case was posterior synechia of the iris caused by touching the iris with the laserbeam. No patient showed tumor recurrence or metastases.
Conclusion: Our preliminary results demonstrated good efficiacy and visual outcome following TTT as single treatment for small choroidal melanomas located posterior to the equator. Long-term follow-up is necessary for data regarding tumor reccurence and metastases.
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