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To analyze the impact of the dose to the optic disc and the irradiated length of the optic nerve on radiation-induced optic neuropathy, radiation-induced retinopathy, iris neovascularization, secondary glaucoma, enucleation, and local tumor control after proton beam therapy (PBT) of choroidal melanoma. Retrospective analysis of 1129 patients, who received primary PBT for the treatment of choroidal melanoma with a dose of 60 cobalt gray equivalents (CGE) between 1998 and 2013 at the Helmholtz-Zentrum Berlin, Germany. Kaplan-Meier curves and logrank test have been used for time-to-event analyses. Adjustment for potential confounders was done using multiple Cox regression models with forward and backward selection. We found a significant correlation between the irradiated length of the optic nerve and the dose to the optic disc (correlation coefficient, 0.93). Multivariate Cox regression revealed the dose to the optic disc as an independent predictive risk factor for the development of radiation-induced optic neuropathy (p < 0.001, HR 1.023, 95 CI 1.016–1.029), iris neovascularization (p < 0.001, HR 1.013, 95% CI 1.008–1.019), secondary glaucoma (p < 0.001, HR 1.017, 95% CI: 1.011-1.023) and enucleation (p < 0.001, HR 1.037, 95% CI 1.020-1.053). The irradiated length of the optic nerve was not a statistically independent predictive risk factor in multivariate analysis. Our data implicate the predominance of the dose to the optic disc over the irradiated length of the optic nerve regarding radiation-induced optic neuropathy, iris neovascularization, secondary glaucoma, and enucleation.

Uveal Melanoma (UM) is the most common primary intra-ocular tumor in adults. New diagnostic procedures and basic science discoveries continue to change our patient management paradigms. A recent meeting of the European Vision Institute (EVI) special interest focus group was held on “Outcome Measures of New Technologies in Uveal Melanoma”, addressing the latest advances in UM, starting with genetic developments, then moving on to imaging and treatment of the primary tumor, as well as to investigating the most recent developments in treating metastases, and eventually taking care of the patient’s wellbeing. This review highlights the meeting’s presentations in the context of the published literature.

Purpose To compare intravitreal therapy with the natural course of radiation optic neuropathy after primary proton beam therapy for choroidal melanoma with respect to long-term visual acuity and development of optic atrophy. Design Retrospective comparative case series. Methods Inclusion criteria: patients treated with primary proton beam therapy for choroidal melanoma with a minimum follow-up of 24 months after the occurrence of radiation optic neuropathy and optic disc imaging during follow-up. Exclusion criteria: pathologic condition of the optic disc before irradiation and intravitreal therapy to treat cystoid macular edema not originating from the optic disc. Results Of 93 patients, 48 were observed only after radiation optic neuropathy, and 45 were treated with intravitreal therapy (triamcinolone, bevacizumab, and/or dexamethasone). Median follow-up was 55 months (29-187 months); median interval between onset of radiation optic neuropathy and the last patient visit was 34 months (24-125 months). Of 48 observed patients, 41 (85.4%) developed an optic atrophy after a median of 14 months (3-86 months) after radiation optic neuropathy; and of 45 intravitreally treated patients, 34 (75.5%) presented with an optic atrophy after a median of 12.5 months (1-55 months) following optic neuropathy, indicating no statistically significant differences between the groups. Comparing the change in visual acuity from occurrence of optic neuropathy to final visual acuity, no statistically significant differences were found between either group (P = 0.579). Conclusions Patients treated with intravitreal therapy for radiation optic neuropathy showed no statistically significant differences related to visual acuity or optic atrophy development from patients who underwent only observation.

ZusammenfassungDie Bildgebung von intraokularen Tumoren ist multimodal, vielseitig einsetzbar, in stetiger Weiterentwicklung. Sie ist damit unerlässlich für die Erkennung, Diagnose, Therapieplanung und Überwachung von intraokularen Tumoren. Für die Diagnostik und Verlaufskontrolle steht ein breites Spektrum bildgebender Verfahren zur Verfügung: die Farbbildaufnahme, Infrarotaufnahme, Autofluoreszenzaufnahme, Fluoreszenzangiografie (FAG) und Indocyaningrünangiografie (ICGA), optische Kohärenztomografie (OCT) und die Sonografie (US). In dieser Arbeit wird an verschiedenen Beispielen die multimodale Nutzung von Bildgebungsverfahren in der Diagnose, Therapie und Nachsorge okulärer Tumoren unter besonderer Berücksichtigung der Aderhautmelanome beschrieben.

This study aims to analyze the effect of salvage proton beam therapy for the treatment of recurrent iris melanoma. In this clinical case series, we retrospectively analyzed the data of eight patients who underwent proton beam therapy of the whole anterior segment as salvage therapy between 2000 and 2016 for recurrent iris melanoma after resection, ruthenium brachytherapy, or sector proton beam therapy. Two patients received salvage proton beam therapy for repeated tumor relapse. All patients were observed and prepared for proton beam therapy at the Charite and irradiated at the Helmholtz-Zentrum Berlin where they received 50 cobalt Gray equivalents (CGE) in four daily fractions. We investigated survival rates and ocular outcome. Median follow-up after salvage proton beam therapy was 39 months. No local recurrence was detected during follow-up. One patient died from hepatic metastases 5.5 years after salvage therapy. Secondary glaucoma occurred in seven out of eight patients during follow-up. Two patients had chronic corneal erosion and two other patients presented with corneal decompensation, necessitating Descemet membrane endothelial keratoplasty (DMEK), and perforating keratoplasty. Median visual acuity was 0.2 logMAR before salvage proton beam therapy and 0.7 logMAR at the end of follow-up. Whole anterior segment salvage proton beam therapy has effectively controlled recurrent iris melanoma in our patients, but has been associated with a high incidence of radiation-induced corneal impairment and secondary glaucoma requiring extensive secondary treatment.

The aim of this study was to evaluate local tumour control, incidence of radiation-induced glaucoma and associated interventions of sector-based and whole anterior segment proton beam therapy (PBT) for the treatment of iris melanoma. We retrospectively analysed the data of 77 patients with iris melanoma who underwent PBT applied as 50 CGE in four daily fractions. Of the patients, 47 received PBT with a circular-shaped collimator and 30 with a conformal sector-shaped target volume. Local control, eye preservation and secondary glaucoma were evaluated. Median follow-up time was 54.9 months. Local tumour control was 100% in patients receiving whole anterior segment irradiation. Two patients developed pigment dispersion in the non-irradiated area after sector-based PBT and received whole anterior segment salvage PBT. The mean volume of ciliary body irradiated was 89.0% and 34.9% for whole anterior segment and lesion-based irradiation, respectively. At the end of follow-up, secondary glaucoma was found in 74.3% of the patients with whole anterior segment irradiation and in 19.2% with sector-based irradiation. Patients with sector-based PBT had a stable visual acuity of logMAR 0.1, while it declined from logMAR 0.1 to 0.4 after whole anterior segment irradiation. We found a significant reduction in radiation-induced secondary glaucoma and glaucoma-associated surgical interventions and stable visual acuity after sector-based irradiation compared with whole anterior segment irradiation. Sector-based irradiation revealed a higher risk for local recurrence, but selected patients with well-circumscribed iris melanoma benefit from applying a lesion-based target volume when treated with sector-based PBT.

Purpose This study was performed to show long-term outcomes concerning globe preservation in uveal melanoma patients after proton beam therapy with the main focus on outcomes according to different adjuvant ab interno surgical procedures. Design Retrospective cohort study. Methods All patients treated with primary proton beam therapy for choroidal or ciliary body melanoma between June 1998 and June 2015 were included. Results A total of 2499 patients underwent primary proton beam therapy, with local tumor control and globe preservation rates of 95.9% and 94.8% after 5 years, respectively. A total of 110 (4.4%) patients required secondary enucleation. Unresponsive neovascular glaucoma was the leading cause of secondary enucleation in 78 of the 2499 patients (3.1%). The 5-year enucleation-free survival rate was 94.8% in the endoresection group, 94.3% in the endodrainage group, and 93.5% in the comparator group. The log-rank test showed P = .014 (comparator group vs endoresection group) and P = .06 (comparator group vs endodrainage-vitrectomy group). Patients treated with endoresection or endodrainage-vitrectomy developed less radiation retinopathy (30.5% and 37.4% after 5 years, P = .001 and P = .048 [Kaplan-Meier], respectively) and less neovascular glaucoma (11.6% and 21.3% after 5 years, P = .001 and P = .01 [Kaplan-Meier], respectively) compared with the comparator group (52.3% radiation retinopathy and 57.8% neovascular glaucoma after 5 years). Conclusion This study suggests that in larger tumors the enucleation and neovascular glaucoma rates might be reduced by adjuvant surgical procedures. Although endoresection is the most promising adjuvant treatment option, the endodrainage-vitrectomy is recommended in patients who are ineligible for endoresection.

Irradiation of choroidal melanoma is a safe and globe preserving procedure. Chronic inflammatory processes and ischemia are the main reasons for secondary enucleation in the long run. The aim of this study was to determine whether intraocular inflammation and especially inflammatory response after proton beam therapy (PBT) is related to primary tumor characteristics such as height, tumor volume, and initial flare values. Twenty-six patients treated for uveal melanoma using PBT were included. All patients were examined for signs of inflammation using laser flare photometry (LFP). Each examination included assessment of the melanoma and fellow eye (which acted as the control) and imaging of the melanoma. Significant differences of flare values between melanoma eyes and control group were found both at baseline (median 17.65 ph/ms (min 4, max 37.10), 7.45 ph/ms (min 0.80, max 16.40), respectively) and during follow-up (median 21.45 ph/ms (min 4.5, max 70.90); 6.05 ph/ms (min 2.40, max 16.40), respectively) (p

Retrospective evaluation of intraocular pressure, use of topical and systemic anti-glaucoma medication, secondary complications, local tumor control and survival in patients treated with trabeculectomy for the regulation of the intraocular pressure (IOP) after proton beam therapy for uveal melanoma. In this retrospective clinical case series we evaluated the follow-up of 15 patients receiving a trabeculectomy as surgical treatment if the IOP could not be lowered adequately by medications or laser surgery. All patients had received proton beam therapy for uveal melanoma at the Helmholtz-Zentrum Berlin between 1998 and 2010. The median IOP decreased significantly from 35 mmHg ± 8.8 before TE to 16 mmHg ± 8.2 (=52.3 %) six months after TE (Wilcoxon-Mann–Whitney-U Test, p

Background Treatment modalities in iris melanoma include excision, plaque radiotherapy, photon or proton beam therapy and enucleation. In extensive tumours and diffuse seeding, radiotherapy remains as an alternative to enucleation. Methods This study is a retrospective, consecutive, interventional, single-institutional case series. 54 patients with a diffuse and non-resectable iris melanoma diagnosed from September 1998 to June 2012 were included. A 68-megaelectron volt proton beam was used to treat the anterior segment with a total dose of 4×12.5 cobalt grey equivalent. The cases were evaluated for local tumour control, eye retention, functional outcome and local complications after treatment. Results During a mean follow-up of 62.7 months (median 54.8 months, range 5.5–159.6 months), local tumour control was achieved in 96.3% of the patients. Cataract and glaucoma were the main complications developing after irradiation in 42.6% and 55.6%, respectively. In 34 of 44 patients (77.3%) who underwent cataract removal, a visual acuity of 20/40 or better following surgery was preserved. Enucleation was performed in three patients. The reason was suspected tumour recurrence in one and glaucoma in two. Hepatic metastasis occurred in one patient. Conclusions As an alternative to enucleation, whole anterior segment fractionated proton beam radiotherapy offered excellent local tumour control in diffuse iris melanoma. Given the limited alternatives, the rate of complications appears acceptable and visual function could be preserved in the majority of the patients during follow-up.

Purpose To evaluate the potential benefit and risk of proton beam therapy in the treatment of symptomatic retinal papillary capillary hemangioma. Design Retrospective interventional case series. Methods This study included patients presenting with symptomatic exudative retinal papillary capillary hemangioma with or without association with von Hippel–Lindau disease. All patients were treated either as a first or a secondary treatment option by proton beam therapy between 2001 and 2009. The minimum follow-up was 30 months. Results Eight eyes of 8 patients (3 male and 5 female, with a mean age of 36 years [range 22–80 years]) were treated for symptomatic papillary retinal hemangioma. The median interval between onset of macular edema and proton beam therapy was 1.7 months (range 0.5–3.3 months). The median follow-up period was 84 months (range 32–106 months) between proton beam treatment and last follow-up. Exudation completely resolved in all but 1 patient after 4.2 months on average (range 2.8–7.2 months). Mean visual acuity prior to proton beam irradiation was 0.7 logMAR (0.2 DIN (DIN 58220 norm)) (range 2-0.3 logMAR) and declined to 0.8 logMAR (0.16 DIN; range 2-0.1 logMAR) at last follow-up examination (no statistical significance, P = .071). Conclusion The anatomic outcome after proton beam therapy for retinal papillary hemangioma is convincing, whereas functional outcome may be compromised because of tumor location, long-persisting macular edema, extensive exudation, and poor initial visual acuity. In patients with extended retinal detachment surgical intervention was still necessary. Although proton beam therapy is proven to be a therapeutic option, treatment will remain challenging.

The aim of this retrospective study was to determine the efficacy of proton beam irradiation in choroidal hemangioma in a long-term follow-up. A total dose of 20 Cobalt Gray equivalent (CGE) was administered to 50 eyes of 50 patients from September 1998 to September 2010. All treated patients presented with a symptomatic tumor. Nine patients were pre-treated by photodynamic therapy (PDT). Visual outcome, tumor regression, and complications resulting from radiation were investigated. The mean follow-up was 55.4 months (range 13–132). Tumor thickness decreased in all patients. Retinal re-attachment was achieved without evidence of tumor leakage. Visual acuity improved by two lines after one year in 43.4 % of patients and after two years in 36.8 % of patients. During the 55.4 months of long-term follow-up the visual acuity improved from 6/15 to 6/12 after proton therapy. Twenty-three patients (46.0 %) developed radiation retinopathy. According to the Finger classification of 2004, 21 patients (42.0 %) showed a stage 1 or 2 (functionally not relevant) retinopathy, and two patients (4.0 %) presented a stage 3 or 4 (functionally relevant) retinopathy. Further complications included sicca syndrome in nine cases, cataract formation in 10 cases, and radiation optic neuropathy in four cases. Proton therapy with 20 CGE is an efficient primary therapy in choroidal hemangioma and is very effective as a secondary treatment after PDT.

Hintergrund: In der Diagnostik der Aderhaut- und Ziliarkorpermelanome gibt es wesentliche Fortschritte in der Bestimmung der Prognose durch Untersuchung zytogenetischer Tumoreigenschaften. Auch die neue TNM-Klassifikation dient der Einschatzung der Uberlebenswahrscheinlichkeit in Abhangigkeit der klinisch bestimmbaren Tumorgrose und -ausdehnung. Material und Methoden: Darstellung der aktuellen diagnostischen und therapeutischen Moglichkeiten des Aderhautmelanoms. Ergebnisse: Wahrend im Ergebnis der lokalen Strahlentherapie mittels Brachy-, Protonen- und Photonentherapie sowie der Tumorchirurgie meistens eine Organerhaltung moglich ist, bleibt die Uberlebenswahrscheinlichkeit im Vergleich zur primaren Enukleation aufgrund einer hamatogenen Mikrometastasierung vor Therapiebeginn unverandert. Schlussfolgerung: Die Prognose der haufigsten intraokularen Tumoren kann gegenwartig lediglich durch eine fruhzeitigere augenarztliche Identifikation und Behandlung verbessert werden.

To identify predictors of treatment response by evaluating long-term outcomes of vasoproliferative retinal tumors after ruthenium-106 brachytherapy.In a retrospective case series, 39 eyes of 38 patients with vasoproliferative retinal tumors received ruthenium-106 brachytherapy between 2001 and 2013. Baseline clinical and morphologic parameters were analyzed regarding posttreatment tumor activity status.Within a median follow-up period of 2.9 ± 2.9 years, overall, a tumor inactivation was achieved in 72% of cases and visual acuity remained stable in 69%. The mean apex dose was 90 ± 23 Gy (range, 51-140 Gy). Mean tumor thickness decreased significantly, from 2.9 ± 0.9 mm to 1.5 ± 1.0 mm (P0.001; paired t-test). Persistence or recurrence of tumor activity occurred in 28% of cases, requiring secondary intervention with intravitreal drug injections, vitrectomy, cryotherapy, or repeated brachytherapy. Comparison of inactive and active vasoproliferative retinal tumors revealed significant correlation between both initial basal tumour diameter and area and subsequent tumour activity status. In particular, a diameter7.5 mm was associated with an 8-fold risk of persistent or recurrent activity, whereas basal area40 mm demonstrated a 6-fold risk (P = 0.009 and 0.021, respectively; Fisher's exact-test). In contrast, tumor thickness was not found to be of prognostic relevance.Ruthenium-106 brachytherapy is an effective and safe therapeutic option for vasoproliferative retinal tumors. Additionally, tumor diameter and area are efficient predictors of persistence or recurrence of tumor activity.

This study was performed in order to evaluate the incidence of radiation retinopathy and optic neuropathy occurring after proton beam therapy for uveal melanoma. Included in this study were all patients who had been treated with primary proton beam therapy for uveal melanoma at the oncology service between May 1998 and June 2014 with a minimum follow-up of 12 months. Excluded were all patients who underwent re-irradiation, or vitrectomy due to exudative retinal detachment or for tumor-resection. During this period, 1127 patients matched the inclusion criteria, of whom 768 (68.1 %) and 463 (41.0 %) developed radiation retinopathy and optic neuropathy after a median time of 18.9 months (2.0–99.84 months) and 19.8 months (0.2–170.4 months), respectively. Mean follow-up was 53.4 months (12–170.4 months). Included were 558 men (49.5 %) and 569 women (50.5 %). Mean age was 61 years (16–89 years). Visual acuity slightly decreased from initial levels of 0.3 logMAR–0.4 logMAR in patients without developing any radiation-induced complication but severely decreased to 1.0 logMAR or 1.5 logMAR in the case of developing radiation retinopathy only or optic neuropathy, respectively. Independent risk factors for radiation retinopathy were a centrally (

Die Protonenstrahlentherapie ist eine Hochprazisionsbestrahlung, die fur umschriebene Tumoren geeignet ist, die sich in der Nahe von kritischen Strukturen befinden und von der Bestrahlung geschont werden mussen. Aderhautmelanome des hinteren Augenpols erfullen durch ihre Nahe zu Makula und Sehnerv diese Kriterien. Durch den sehr steilen distalen und lateralen Dosisabfall des Protonenstrahls, konnen diese Strukturen optimal aus dem Bestrahlungsfeld herausgehalten werden, so dass optimale funktionelle Ergebnisse erzielt werden konnen. Zudem fand sich bei den 336 Patienten eine lokale Tumorkontrollrate von 97,3% und ein Augenerhalt von 94,5% in 3 Jahren. Die Strahlenretinopathie und die strahleninduzierte Opticusneuropathie betrugen 53% respektive 54% nach 3 Jahren. Der mittlere Visus fiel von ursprunglich 0,5 auf 0,27 ab. Zusammenfassend bietet die Strahlentherapie mit Protonen bei Aderhautmelanomen des hinteren Augenabschnittes hervorragende lokale Tumorkontrollraten und funktionelle Ergebnisse, so dass der etwas erhohte medizinische Aufwand allenfalls gerechtfertigt ist.

To evaluate the incidence, risk factors, and dosages of proton beam therapy associated with cataract development, and long-term visual outcomes after treatment of uveal melanoma. All patients receiving primary proton beam therapy for uveal melanoma between 1998 and 2008 with no signs of cataract before irradiation were included. A minimum follow-up of 12 months was determined. Exclusion criteria included all applied adjuvant therapies such as intravitreal injections, laser photocoagulation, tumor resections, or re-irradiation. For subgroup analysis, we included all patients who underwent brachytherapy between 1998 and 2008 for uveal melanoma, considering the above mentioned inclusion and exclusion criteria. Two hundred and fifty-eight patients matched our inclusion criteria. Median follow-up was 72.6 months (12.0-167.4 months). Of these 258 patients, 71 patients (66.3 %) presented with cataract after 31.3 months (0.7–142.4 months), of whom 35 (20.4 %) required surgery after 24.2 (0.7–111.1 months) to ensure funduscopic tumor control. Kaplan–Meier estimates calculated a risk for cataract of 74.3 % after 5 years. There was no increase in metastasis or local recurrence in these patients. Patient’s age was the sole independent statistically significant risk factor for cataract development. The probability of cataract occurrence significantly increased with doses to lens exceeding 15–20 CGE. Neither the appearance of cataract nor cataract surgery influenced long-term visual outcome. Cataract formation is the most frequent complication after irradiation. There is no benefit vis-a-vis brachytherapy with regard to cataract development. Data indicate a dose–effect threshold of 0.5 CGE for cataractogenesis, with significantly increasing risk above a dose of 15 CGE. Furthermore, cataract surgery can be performed without an increased risk for metastasis.

Purpose To evaluate the risk factors, recurrence rates, retreatments, and long-term patient outcomes following proton beam therapy for uveal melanoma. Design Retrospective interventional case series. Methods All patients treated with primary proton beam therapy for uveal melanoma at the oncology service at Charite-Berlin and Helmholtz-Zentrum-Berlin between May 1998 and December 2008 were reviewed for local recurrence. Of 982 patients, 982 eyes matched the inclusion criteria. The data were obtained from electronic health records, operative reports, discharge letters, and radiation planning. Comparisons of fundus photographs and ultrasound measurements were performed to assess the growth pattern of the tumor and to determine the success of retreatment, in the case that a globe-retaining therapy was undertaken. Results Of 982 patients, 35 patients (3.6%) developed local recurrence. The median follow-up was 60.7 months (6.0–170.4 months). Local control rate was 96.4% and the overall eye retention rate was 95.0% in this cohort. Local recurrence was correlated with a higher risk for metastasis and reduced survival. Largest tumor diameter was identified as the sole statistically significant risk factor for local recurrence ( P = .00001). All globe-retaining retreatment approaches for local recurrence, including proton beam therapy, brachytherapy, and transpupillary thermotherapy used for recurrences at the tumor margins, showed good local tumor control and similar metastasis-free survivals. Conclusions This study showed that each globe-retaining retreatment approach can result in satisfying local tumor control. In case of early detection of local recurrence, preservation of the globe can be warranted. Therefore, regularly performed follow-ups should be ensured.

Einleitung: Uveale Metastasen stellen den haufigsten intraokularen malignen Tumor dar. Uber 90% entwickeln sich in der Choroidea und weniger als 10% in Iris und Ziliarkorper. Bis zu 34% der Patienten mit Metastasen haben zum Zeitpunkt der ophthalmologischer Erstvorstellung keine bekannte systemische Krebserkrankung, so dass in diesen Fallen der Augenarzt die Weichen fur den weiteren Krankheitsverlauf stellen muss. Um den Primarius zu finden, werden entweder eine Biopsie der uvealen Metastase oder ein onkologisches Screening durchgefuhrt. Methoden: Wir haben alle Patienten, die sich zwischen 2002 und 2014 mit uvealen Metastasen vorstellten, anhand ihrer Therapiemodalitat ausgewertet. Ergebnisse: Insgesamt haben wir im oben genannten Zeitraum 65 Patienten behandelt von denen 27% mit Chemotherapie, 20% mit perkutaner Bestrahlung des Auges, 7% mit Ganzhirnbestrahlung, 4% mit Brachytherapie, 4% mit Protonentherapie, 4% mit Enukleation und 3% mit intravitrealem Bevacizumab behandelt wurden. 24% der Patienten erhielten eine Kombinationstherapie aus den o.g. Optionen und 7% wurden beobachtet. Diskussion: Histopathologische Sicherung der Metastase und damit des Primarius ermoglicht eine Form der zielgerichteten Therapie (z.B. Herceptin® gegen HER2 neu bei Mamma-Ca, Vemurafenib® als BRAF-Inhibitor beim kutanen Melanom, etc.). Geht die Metastase durch systemische Chemotherapie nicht zuruck, stellt die Bestrahlung eine sehr gute Option dar. Intravitreal injiziertes Bevacizumab wird erst neuerdings in Fallberichten bei uvealen Metastasen als off-label-use angewandt. Dies scheint zum jetzigen Zeitpunkt sehr erfolgreich, jedoch bleiben die Langzeitergebnisse und grosere Studien noch abzuwarten. Zusammenfassend richtet sich die Behandlung nach Grose, Symptomen, Primarius und naturlich Allgemeinzustand des Patienten. Es gibt somit kein klassisches Therapieschema, sondern eine interdisziplinar geplante und individuell auf den jeweiligen Patienten angepasste Therapie.

Einleitung: Aderhautmelanome gehen oft mit einer visusbedrohenden, exsudativen Begleitablatio einher. Eine Endoresektion des Tumorgewebes ist bei zentralen Tumoren mit einer unabdingbaren Visusminderung, bei Ziliarkorpertumoren mit einer erhohten Blutungsgefahr verbunden. Diese Studie untersucht, ob die alleinige Vitrektomie mit Endodrainage und Silkonoltamponade in Kombination mit einer intraoperativen Laserung der Tumoroberflache zu einer dauerhaften Netzhautanlage fuhren kann. Methodik: Es wurden 26 Patienten mit choroidalen Melanomen (n=24 mit AHMM, n=2 mit AHZKMM) untersucht, die im Zeitraum von 2003–2011 nach Protonentherapie (N=24) oder Ruthenium (n=2) bei persistierender, exsudativer Ablatio eine PpV mit Silikonoltamponade erhalten haben. Untersucht wurden Tumorkontrolle, Visus, Netzhautanlage und Komplikationen. Ergebnisse: Follow-Up Zeit betrug im Median 17,1 Monate (4,2–95,1) Monate. Die Tumorprominenz betrug im Median 6,1mm bei einem maximalen Durchmesser von 14,4mm vor Bestrahlung. Im Follow-Up lag die Prominenz bei 3,4mm (p