1Foerster M. H., 1Bechrakis N. E., 3Heese U., 2Nausner M., 1Kreusel K. M. , 1Zöller I.

Augenklinik1 und Strahlenklinik2, Klinikum Benjamin Franklin, Freie Universität Berlin, D 12200 Berlin, Hahn-Meitner Institut3, Berlin Wannsee

Objective: Transscleral resection of intraocular melanomas has been shown to be successful in large peripheral tumors. Adjuvant brachytherapy has reduced the rate of recurrencies. However, surgery of large tumors at the posterior pole bear increasing risks of functional loss and secondary enucleation. Endoresection in combination with presurgical radiation therapy is an alternative treatment modaltity for these eyes.
Methods: Due to the homogeneous dose distribution protone therapy was selected for presurgical radiation. Thirteen patients underwent endoresection of highly prominent intraocular melanomas following a 4- times fractionated radiation with 60 GyE. Retinectomy, chroidectomy and endolaser hyperthermia was applied.
Results: The average preoperative prominence was 8.2 mm and the mean visual acuity was 20/30. The mean follow-up was 6 months. One eye with a tumor elevation of 9.5 mm and a preoperatively severe subretinal hemorrhage had to be removed due to neovascular glaucoma 4 months after primary surgery. The average postoperative visual acuity was 20/100. Up to date no recurrencies were observed, but additional vitreoretinal surgery was required in some cases.
Conclusion: Although the follow-up is only 6 months endoresection seems to be a promising therapeutic modality in prominent posteriorly located intraocular tumors. However tumor cell seeding is of serious concern during this procedure. Therefore we recommend presurgical radiation as a necessary prerequisite. Possibly the removal of the necrotic tumor reduces complications.

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