Inadvertent Scleral Perforation During Choroidal Melanoma Surgeries: Incidence, Risk Factors, Management, and Outcomes

IF 4.2 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-05-31 DOI:10.1016/j.ajo.2025.05.043

HUNG-DA CHOU , HEINRICH HEIMANN , BERTIL E. DAMATO , RUMANA N. HUSSAIN

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Abstract

Objective

To determine the incidence, risk factors, management, and outcomes of inadvertent scleral perforation during primary choroidal melanoma surgeries.

Design

A retrospective interventional case series from a national ocular oncology referral center.

Subjects

One thousand and eighty-one consecutive patients with choroidal melanoma who underwent primary ruthenium plaque or tantalum fiducial marker implantation surgery between January 2011 and December 2023 were reviewed from a clinical registry.

Intervention

Plaque surgery (n = 697) or marker surgery (n = 684).

Main Outcomes and Measures

Incidence and risk factors of inadvertent intraoperative scleral perforation and the related management and clinical outcomes.

Results

The incidence of scleral perforation was 6/697 (0.86%) for plaque and 1/684 (0.15%) for fiducial marker surgeries. Five of the 7 eyes with perforation had myopia or thin sclera. All perforations occurred between 16.3-17.6 mm from the fovea, corresponding to the equatorial region. Immediate management included cryotherapy (7/7 eyes), wound suturing (2/7 eyes), and intravitreal gas (2/7 eyes). During plaque removal surgery, the original scleral wound was torn open in 2/7 eyes, and scleral buckling was undertaken for the presence of perforation-associated subretinal fluid in 4/7 eyes. After a mean follow-up of 38 months (range, 9-87 months), no retinal detachment was noted, and the visual acuity remained unchanged in 5/7 eyes. All the tumors regressed, and there were no signs of seeding.

Conclusions

The incidence of inadvertent scleral perforation during plaque and fiducial marker implantation was low, and with immediate intervention, the prognosis was favorable. Myopic eyes, eyes with thin sclera, and suturing in the equatorial zone might be the risk factors. During plaque removal, we recommend combined scleral buckling to address perforation-related subretinal fluid and emphasize avoiding traction on the sclera to prevent a second tear. Further prospective studies are needed to understand this complication more comprehensively.

查看原文本刊更多论文

脉络膜黑色素瘤手术中意外巩膜穿孔：发病率、危险因素、管理和结果：黑色素瘤手术中的巩膜穿孔。

目的：确定原发性脉络膜黑色素瘤手术中意外巩膜穿孔的发生率、危险因素、处理和结局。设计：来自国家眼科肿瘤转诊中心的回顾性介入病例系列。研究对象：在2011年1月至2023年12月期间，从临床登记中回顾了181例连续接受原发性钌斑块或钽基准标志物植入手术的脉络膜黑色素瘤患者。干预：斑块手术（n = 697）或标记手术（n = 684）。主要观察指标：术中意外巩膜穿孔的发生率、危险因素、处理及临床结果。结果：斑块手术巩膜穿孔发生率为6/697(0.86%)，基准标记手术发生率为1/684（0.15%）。7只穿孔眼中有5只为近视或巩膜薄。所有穿孔均发生在距中央窝16.3 ~ 17.6 mm之间，对应赤道区域。立即处理包括冷冻治疗（7/7眼）、伤口缝合（2/7眼）和玻璃体内气体治疗（2/7眼）。在斑块去除手术中，2/7只眼的原始巩膜伤口被撕开，4/7只眼因存在穿孔相关的视网膜下积液而进行巩膜扣带。平均随访38个月（范围9 ~ 87个月），未见视网膜脱离，5/7眼视力保持不变。所有的肿瘤都消退了，没有生长的迹象。结论：在斑块和基准标记物植入过程中，非故意巩膜穿孔的发生率较低，及时干预，预后良好。近视眼、巩膜薄眼和赤道区缝合可能是危险因素。在去除斑块时，我们建议联合巩膜扣带来解决穿孔相关的视网膜下积液，并强调避免牵拉巩膜以防止第二次撕裂。需要进一步的前瞻性研究来更全面地了解这一并发症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.