Treating thick uveal melanoma saving vision - a collaborative study

It is difficult to save the eye and useful vision when an intraocular melanoma is very thick. We tend to remove such tumours surgically, through a trapdoor in the wall of the eye. At Helsinki University Central Hospital, Finland, these tumours are treated with radiotherapy, using an iodine-125 plaque.

Ilkka Puusaari, Tero Kivelä and Bertil Damato therefore merged their results to compare the two treatments. Local resection was more likely to conserve vision, but at a greater risk of local tumour recurrence.

Since patients in this study were treated, local resection techniques have developed so that local recurrence is much rarer than before. This improvement has been achieved by giving a small dose of radiotherapy after the local resection, using a ruthenium-106 plaque.

Another approach is to give proton beam radiotherapy and then to remove the tumour surgically before it causes toxic damage to the eye. Recently, thanks to this combined approach, the captain of a passenger jet was able to keep his pilot’s licence and to continue to fly jumbos internationally. (Puusari I, Kivelä T and Damato B. Transscleral local resection versus iodine brachytherapy for uveal melanomas that are large because of tumour height. Graefes Arch Clin Exp Ophthalmol. 2006 Nov 18; [Epub ahead of print]).