Endoresection in high posterior choroidal melanomas: long-term outcome

Abstract

Background: Eyes with high posterior choroidal melanomas are frequently enucleated because of the potential complications of radiotherapy. The aim of this study was to evaluate the safety and efficacy of endoresection at long-term follow-up.

Methods: Retrospective, non-randomised, interventional case series. Thirty-eight patients underwent endoresection. For primary procedures, inclusion criteria were tumour thickness >or=8 mm, base <15 mm, tumours not exceeding the equatorial area. Endoresection was also undertaken as the salvage procedure in four patients. Main outcomes measured were metastatic disease, survival, local recurrences, visual acuity, enucleation rate, and surgical complications.

Results: Follow-up time ranged from 23 to 129 months (mean 70.63 months). Preoperative visual acuity ranged from "hand-movements" to 20/20 (mean, 20/60). In primary cases, mean tumour thickness was 10.1 mm and mean base diameter 9.9 mm. At the latest visit, 92.1% patients still retained the eye. Final visual acuity ranged from "no light perception" to 20/30 (mean 20/300). Two patients experienced local recurrence before 3 years of follow-up. Melanoma metastatic disease was found in two patients at 5 years of follow-up. Kaplan-Meier survival analysis for all causes was 88.2% at 5 years. Specific survival was 90.9% at 5 years.

Conclusions: At long-term follow-up, the risk of metastasis or local recurrence, and survival rates were similar to other techniques, although comparisons are difficult because of the unusual presentation of this type of melanoma. Further studies and longer follow-up are needed.