Minimally Invasive Vitrectomy Combined with Local Intact Exfoliation for the Treatment of Choroidal Melanoma

Abstract

Objective: To observe the effect of minimally invasive vitrectomy combined with local complete exfoliation in the treatment of choroidal melanoma. Methods: By retrospective analysis, 13 choroidal melanoma patients (13 eyes) were selected in the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from January 2014 to December 2017. The patients were treated with minimally invasive vitrectomy combined with complete local exfoliation. Systemic metastasis and local scleral and optic nerve invasion were excluded. Mean basal diameter of the tumor was 11.2±4.2 mm. Average height diameter was 9.2±1.1 mm. Tumors were located at the posterior pole and at the equator in 11 cases. Minimally invasive vitrectomy was adopted in combination with intraventricular resection, then the tumors were removed completely. Two of the tumors were large enough to reach the anterior equatorial ciliary body. Minimally invasive vitrectomy was adopted in combination with tumor dissection from the scleral flap. The patients underwent primary surgery with silicone oil and lens retention. Patients were followed up from postoperative 6 months to 54 months. Local and systemic exams were done every 6 months. Results: All 13 patients were diagnosed with choroidal melanoma by pathological diagnosis. During the follow-up, there was no recurrence, or systemic or ocular metastasis. Postoperative best corrected visual acuity (BCVA) was 0.3-0.9 LogMAR, 0.8-0.9 LogMAR (38.4%) in 5 patients and BCVA 0.3-0.8 LogMAR (61.5%) in 8 patients. After 3 months, 13 patients underwent silicone oil extraction. Phacoemulsification was performed on 8 patients with complicated cataract, and intraocular lens implantation was performed on 5 patients. Three patients (23.1%) had proliferative retinopathy at the tumor resection site after surgery, and silicone oil was used again to reposition the retina without intraocular lens implantation. Conclusions: Based on the size and location of the tumor, complete intraocular and extraocular local exfoliation combined with minimally invasive vitrectomy is an effective method for the treatment of choroidal melanoma. It preserves both the eyeball and vision. Key words: choroidal melanoma; minimally invasive surgery; vitrectomy; combined surgery