Ocular treatment of uveal melanoma
Prof. Bertil Damato
Without timely treatment, ocular melanomas can make the eye blind, inflamed, painful and unsightly. In most centres, in first choice of treatment is plaque radiotherapy. In Europe, most use the ruthenium plaque, which can treat tumours up to 5 mm in thickness. In the United States, the iodine plaque is favoured because it can treat larger tumours, but with a greater risk of damaging healthy tissues in the eye. It is conventional practice to position the radioactive plaque so that it overlaps all the tumour margins by at least 2 mm in case the plaque is not placed correctly (i.e., 'safety margin'). We have developed methods for positioning the plaque with great accuracy so that it can be placed as far from the optic nerve as possible. This makes it possible to conserve more vision without increasing the risk of local tumour recurrence.
After radiotherapy, many eyes become blind and painful. Several others have tried various methods of administering the radiation, to avoid this complication, but without success. Once this problem develops, it is difficult to reverse with treatment. We have found that this complication can be treated successfully by removing the irradiated tumour and this proves that it is the dead tumour that is causing the problem (i.e., 'toxic tumour syndrome').
The toxic tumour syndrome after radiotherapy is more likely to occur with large melanomas. We have developed techniques for removing such tumours surgically through a large trapdoor in the eye. This is highly complex surgery, also requiring special general anaesthesia to lower the blood pressure.
When a melanoma extends close to the optic nerve, radiotherapy is usually followed by severe loss of vision, which occurs because of optic nerve damage caused by the radiotherapy. We have developed methods for removing such tumours with a mini-vacuum cleaner (i.e., 'endoresection').
Without timely treatment, ocular melanomas can make the eye blind, inflamed, painful and unsightly. In most centres, in first choice of treatment is plaque radiotherapy. In Europe, most use the ruthenium plaque, which can treat tumours up to 5 mm in thickness. In the United States, the iodine plaque is favoured because it can treat larger tumours, but with a greater risk of damaging healthy tissues in the eye. It is conventional practice to position the radioactive plaque so that it overlaps all the tumour margins by at least 2 mm in case the plaque is not placed correctly (i.e., 'safety margin'). We have developed methods for positioning the plaque with great accuracy so that it can be placed as far from the optic nerve as possible. This makes it possible to conserve more vision without increasing the risk of local tumour recurrence.
After radiotherapy, many eyes become blind and painful. Several others have tried various methods of administering the radiation, to avoid this complication, but without success. Once this problem develops, it is difficult to reverse with treatment. We have found that this complication can be treated successfully by removing the irradiated tumour and this proves that it is the dead tumour that is causing the problem (i.e., 'toxic tumour syndrome').
The toxic tumour syndrome after radiotherapy is more likely to occur with large melanomas. We have developed techniques for removing such tumours surgically through a large trapdoor in the eye. This is highly complex surgery, also requiring special general anaesthesia to lower the blood pressure.
When a melanoma extends close to the optic nerve, radiotherapy is usually followed by severe loss of vision, which occurs because of optic nerve damage caused by the radiotherapy. We have developed methods for removing such tumours with a mini-vacuum cleaner (i.e., 'endoresection').
