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Scientists investigate an alternative to eye removal and chemotherapy. Scientists investigate an alternative to eye removal and chemotherapy., Author Affiliations: A tumour called a retinablastoma appears as a light-coloured bulge at the back of the right eye in this magnetic resonance imaging scan. Credit: Zephyr/SPL MRI scan of [...]

Br J Ophthalmol 2003;87:1370-1373 Aim: To evaluate the results of combined plaque radiotherapy and transpupillary thermotherapy (TTT) in 50 consecutive patients 5 years after treatment. Methods: 50 adult patients with [...]

Background: Improved local treatment of uveal melanoma makes it possible for many patients to retain the affected eye, but a proportion will develop secondary complications such as neovascularisation of the [...]

Melanomas are malignant neoplasms composed of cells able to produce melanin, the brown or black pigment that occurs naturally in the iris and choroid (vascular tunic of the eye). Treatment for choroidal melanomas located at the back of the uvea (the pigmented vascular tunic of the eye which includes the iris, ciliary body and choroid) has traditionally been treated with enucleation (removal of the eye). Unfortunately, this radical treatment has not increased survival. Malignant tissue selectively retains a photosensitizing agent; when this photosensitizing agent is activated by an appropriate wavelength of light it causes tumor destruction. A report is presented of the effectiveness of phototherapy in treating a small group of 19 patients with uveal melanoma. One patient received three treatments; 11 patients received two. Treatment produced complete tumor regression in six patients (31 percent); five patients experienced minor to significant tumor regression. The longest tumor control achieved was 31 months. One patient died from cancer spread to the liver, two years after phototherapy. It was found that lighter rather than darker tumors responded much better to phototherapy. Also, if the tumor did not initially respond to phototherapy, additional treatments were unlikely to be beneficial. The advantages of phototherapy are that it is noninvasive and may be repeated if necessary. The results of this study suggest that phototherapy may be useful in treating small and medium-sized, light to moderately pigmented posterior uveal melanomas. (Consumer Summary produced by Reliance Medical Information, Inc.)

Melanoma of the conjunctiva (mucous membrane lining the eyelids and front surface of the eyeball) occurs in only about 2 percent of eye melanomas. Melanoma is a malignant neoplasm composed of cells able to produce melanin, a naturally occurring pigment found in the iris and choroid of the eye. A study was undertaken of 81 patients treated between 1960 and 1988 for conjunctival melanoma; the goal of the research was to identify factors that influence the disease outcome. The average follow-up lasted 5.5 years, with 54.3 percent of patients followed for more than five years. The average age of the patients at the time of initial examination was 55 years. In 73 percent of patients the conjunctiva overlying the eyeball was the site of the melanoma. Treatment included local excision in 16 patients; local excision and brachytherapy (placement of radioactive sources in contact with the malignant tissue) in 32 patients; local excision with cryotherapy (freezing) in 16; brachytherapy in 12; beam radiotherapy in three; and local excision with brachytherapy and cryotherapy in two patients. Complete regression of melanoma was achieved in 62 patients (76.5 percent); there was a recurrence in 19 patients (23.5 percent); and 15 (18.5 percent) died from metastasis (spread of the cancer). Most deaths from metastasis occurred within five years. Five-year survival (using death from any cause) was 76 percent, and 10-year survival was 60 percent. The survival rate after eight years for patients with small tumors was 88.5 percent, significantly higher than the survival rate (65 percent) for patients with larger tumors. The recommended treatment is local excision followed by beta-ray brachytherapy or cryotherapy. It should be noted that the course and progression of conjunctival melanomas is unpredictable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Melanoma is a malignant neoplasm composed of cells able to produce melanin, the brown or black pigment that occurs naturally in the eye in the iris and choroid, the vascular tunic covering the posterior five-sixths of the eye. When choroidal melanoma extends beyond the sclera (the opaque membrane covering the choroid, which along with the cornea makes up the outer tunic of the eye), there is poor prognosis for control of the tumor. Mortality without extrascleral extension is 39 percent, compared with between 66 and 73 percent when there is extrascleral spread. Treatment for choroidal melanoma is removal of the eye (enucleation), but there is controversy over the extent of surgery necessary when there is extrascleral spread. A report is presented of the outcome of 17 patients treated surgically for malignant melanoma of the choroid with extrascleral extension. These patients all underwent enucleation and subsequent radiotherapy to the orbit (depression in the skull bones that contains the eye structures). Surgery was performed between 1964 and 1982 and all patients were followed-up. Fourteen of the 17 patients have died, 11 from spread of disease. Tumor recurrence in the orbit occurred in only one patient. The actuarial survival at five years was 51 percent, 44 percent at 10 years, and at 15 years, 33 percent. Although these findings do not provide conclusive evidence of better survival with the use of adjuvant orbital radiotherapy, it may be useful in selected cases. (Consumer Summary produced by Reliance Medical Information, Inc.)