Endoresection with reattachment may preserve eyes with melanoma-induced retinal detachment

Late endoresection with silicone oil assisted reattachment may preserve eyes with longstanding retinal detachment caused by regressed uveal melanoma, according to a study by researchers in Austria.

Gerald Langmann, MD, and colleagues studied five patients with a median tumor prominence of 9.3 mm and a median basal diameter of 13 mm who underwent single fraction Gamma Knife radiosurgery with a marginal dose of 30 Gy. The patients had a retinal detachment of one to two quadrants before radiosurgery, which postoperatively progressed to near total retinal detachment lasting between 3 and 18 months, despite sufficient tumor control.

All of the patients also showed neovascularization of the iris after radiosurgery, while two patients showed secondary glaucoma development, according to the study.

The researchers performed phacoemulsification, pars plana vitrectomy with retinotomy, endoresection and silicone oil tamponade as an alternative therapy to enucleation.

Postoperatively, IOP normalized in all but one eye, which had recurrent bleeding and developed rapid neovascularization of the iris. Additionally, silicone oil was removed in three eyes, the authors reported.

At 27 months follow-up, IOP was still normal and the retina remained reattached in all but one eye, which had residual peripheral proliferative vitreoretinopathy, they found.

Risk factors for longstanding retinal detachment with anterior and posterior segment neovascularization included a retinal detachment of one to two quadrants before therapy, a high dose rate of the new cobalt sources of the Gamma Knife and a large tumor volume, the authors noted.

"Despite sufficient tumor regression and preservation of the globe, visual acuity remains poor," they said.

This study is published in the July issue of Spektrum der Augenheilkunde.