Krause L., Heinrich S., Bechrakis N. E., Kreusel K. M., Foerster M. H.

Augenklink, Univ.-Klinkum Benjamin Franklin, FU Berlin, Hindenburgdamm 30, D-12200 Berlin

Objective: The therapeutic effect of proton beam irradiation on choroidal melanoma is still not completely understood. We performed fluorescein angiography (FA) and indocyanine-green angiography (ICG-A) to identify vascular patterns in these tumors, and to follow changes of these patterns after treatment.
Methods: 40 eyes with choroidal melanoma ( mean size 3.7 mm, range 1.2-7.5 mm) were examined in a prospective study with ICG-A using the scanning laser ophthalmoscope (SLO, Rodenstock). FA was performed using Zeiss fundus camera. All tumors had paramacular or parapapillary localisation. Angiography was performed three, six, twelve month following irradiation, respectivly.
Results: On ICG-A, 89% of melanomas showed a blockage of the background staining. On FA, 33% of tumors showed intratumoral vessels. The blockage of the background staining was comparable to ICG-A. Three month after proton beam irradiation no angiographic changes were found. However, six and twelfe month after therapy tumor vessels showed microaneursm, irregular vessel walls and loss of capillaries.
Conclusion: Proton beam irradiation of choroidal melanoma leads to severe structural changes of tumor vascularisation, which are not present early after therapy. ICG-A is superior to FA in characterisation of these changes.

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