VITREORETINAL SURGERY IN THE COMBINED TREATMENT OF UVEAL MELANOMA

Abstract

Organ-preserving methods for surgical treatment of uveal melanoma include transscleral tumor resection and endosurgical tumor resection. There are several approaches to vitreoretinal intervention worldwide. In particular, endoresection can be performed before or after radiation treatment, and can also be used as the only method. Material and methods. The article presents the results of the treatment of two patients with uveal melanoma T3N0M0. In both cases, endosurgical excision of the choroid tumor with brachytherapy in the neoadjuvant mode was performed. Results. In both cases surgical treatment was carried out after stabilization of the tumor process. In one patient stabilization occurred after the initial brachytherapy, in the second after brachytherapy and four sessions of transpupillary thermotherapy due to continued tumor growth. Prior to treatment, patients underwent delimiting laser coagulation of the tumor focus. In both cases, post-radiation complications were observed in the form of maculopathy and opticoneuropathy, for which conservative therapy was carried out. Tumors were removed within healthy tissues. Conclusion. Diagnosis and treatment of uveal melanoma requires an integrated, multidisciplinary approach. Large tumors often require a combination of techniques. Vitreoretinal surgery allows to remove a tumor site, while, according to the literature, it shows the best results in combination with radiation treatment methods. By eliminating the toxic effects of destroyed tumor cells, it is often possible to stop the manifestations of post-radiation complications. However, due to the small size of the tumor tissue fragments obtained during endoresection, the histological evaluation of the tumor pathomorphism and the immunohistochemical study are diffcult.

Keywords

• uveal melanoma
• choroid melanoma
• vitreoretinal surgery
• endoresection