V 425
Results of treatment of intraocular malignant melanoma with diode laser transpupillary thermotherapy
J. Kociecki, K. Pecold, A. Wieckowska
Purpose of the Study: The purpose of the study was evaluation of effectiveness of diode laser transpupillary thermotherapy and determining in what extent it may act as the only method of therapy of choroidal tumors, and when it should be used in combination with other methods.
Patients and Method: 51 eyes of 49 patients aged 31 to 82 years (mean - 55 years) were evaluated. In 43 patients primary intraocular tumor was diagnosed, and in 5 patients it was metastasis. In 47 cases the tumor occurred unilaterally, whereas in 2 cases bilaterally. The follow-up time ranged from 2 to 25 months. From the evaluated group 11 eyes were excluded because of short time of follow-up (less than 3 months) and when the regular observation after procedure was impossible. All patients were treated with transpupillary thermotherapy (TTT) with the use of diode laser OcuLight SLx, IRIS Medical Instruments, Inc. Mean power used for the treatment was 600 mW, while mean exposure time was 1 minute and the laser spot size ranged from 1,2 to 3 mm.
Results: In 28 cases (70%) of 40 eyes tumor regression, in 6 eyes (15%) stabilization and in 6 (15%) progression was stated. As to complications and side effects visual field scotomas in treated area, hemorrhage to the vitreous, PVR, secondary neovascular glaucoma and exudative retinal detachment were found during the treatment and follow-up. In 2 cases improvement of visual acuity was stated.
Conclusions: 1. In selected cases transpupillary thermotherapy (TTT) can be effective especially in regard to small tumors (height up to 4,5 mm). Perhaps in the future it will be the only method of treatment. 2. Treatment of larger tumors (height more than 4,5 mm) should be connected with the use of ruthenium plaque (106Ru) in order to speed-up the treatment and increase the chances for total tumor regression. 3. Depending on clinical image and obtained therapeutic effects the treatment should be multiply repeated. 4. Intensive tumor pigmentation allows for better control of the TTT procedure. 5. All complications and side effects stated in the course of treatment were not dangerous to the eye, however in some cases further treatment may be problematic or even impossible. 6. Because of long time of exposure and marked pain during procedure small tumors should be treated under peribulbar anesthesia; it allows for better control of the treatment. With longer follow-up of greater group of patients probably it will be possible to establish optimal parameters, advantages and eventual other complications of such a therapy.
Klinika Okulistyczena A. M., Im. K. Marcinkowskiego, 61-848 Poznan, ul. Dluga ½, Polska