Klinische Monatsblatter fur Augenheilkunde · 2006
[Tumor regression and visual outcome after transpupillary thermotherapy (TTT) for malignant choroidal melanoma].
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Stoffelns B M
Аннотация
BACKGROUND: The aim of this study was to evaluate the course of tumor regression and visual impairment in choroidal melanomas treated by transpupillary thermotherapy (TTT) alone.
PATIENTS AND METHODS: In a prospective, non-randomized analysis 26 patients suffering from primary choroidal melanoma (posterior to the equator with base < or = 12 and thickness < or = 4.5 mm) were treated with the TTT standard protocol and followed for 33 - 45 months. Fluorescein and ICG angiographies were performed initially and after tumor regression clinically.
RESULTS: 22 tumors were significantly flattened after 1 - 3 TTT sessions. 4 tumors required additional therapy with ruthenium plaque. Visual acuity remained unchanged or improved in 11 eyes. In all eyes fluorescein and indocyanine green angiography revealed a sharp demarcation of the heat-treated area. Except for macular edema and gliosis in 6 eyes no vascular or retinal tissue damage was noticed outside the treatment zone. In the periphery of the treatment zone all eyes showed residual choriocapillaries remaining perfused. During follow-up 2 eyes revealed tumor regrowth at the posterior margin of the scar, which was successfully managed by TTT or a ruthenium plaque. 2 eyes developed late choroidal neovascularizations (CNV) in the heat-treated area. One patient died of liver metastases.
CONCLUSIONS: Fluorescein and indocyanine green angiographic findings after TTT for small choroidal melanomas suggest that the tissue damage in the choroidal layer is less effective, which perhaps can lead to a higher rate of tumor regrowth. Development of choroidal neovascularization may be a sign of late heat-induced side effects of TTT.
PATIENTS AND METHODS: In a prospective, non-randomized analysis 26 patients suffering from primary choroidal melanoma (posterior to the equator with base < or = 12 and thickness < or = 4.5 mm) were treated with the TTT standard protocol and followed for 33 - 45 months. Fluorescein and ICG angiographies were performed initially and after tumor regression clinically.
RESULTS: 22 tumors were significantly flattened after 1 - 3 TTT sessions. 4 tumors required additional therapy with ruthenium plaque. Visual acuity remained unchanged or improved in 11 eyes. In all eyes fluorescein and indocyanine green angiography revealed a sharp demarcation of the heat-treated area. Except for macular edema and gliosis in 6 eyes no vascular or retinal tissue damage was noticed outside the treatment zone. In the periphery of the treatment zone all eyes showed residual choriocapillaries remaining perfused. During follow-up 2 eyes revealed tumor regrowth at the posterior margin of the scar, which was successfully managed by TTT or a ruthenium plaque. 2 eyes developed late choroidal neovascularizations (CNV) in the heat-treated area. One patient died of liver metastases.
CONCLUSIONS: Fluorescein and indocyanine green angiographic findings after TTT for small choroidal melanomas suggest that the tissue damage in the choroidal layer is less effective, which perhaps can lead to a higher rate of tumor regrowth. Development of choroidal neovascularization may be a sign of late heat-induced side effects of TTT.