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PHOTODYNAMIC THERAPY AS PRIMARY TREATMENT FOR SMALL CHOROIDAL MELANOMA

Turkoglu, Elif B., MD*,†; Pointdujour-Lim, Renelle, MD*,‡; Mashayekhi, Arman, MD*; Shields, Carol L., MD*

doi: 10.1097/IAE.0000000000002169
Original Study: PDF Only

Purpose: To report outcomes of photodynamic therapy (PDT) as primary treatment for small amelanotic choroidal melanoma.

Methods: Retrospective interventional case series of 12 patients with small choroidal melanoma treated with standard-fluence PDT (83 seconds; 50 J/cm2) using verteporfin.

Outcome measures: Tumor regression, subretinal fluid resolution, best-corrected visual acuity, and PDT complications.

Results: There were 12 eyes with melanoma, demonstrating amelanotic (10 [83%]) or lightly pigmented (n = 2, 17%) appearance. The mean tumor thickness was 2.7 mm (median, 2.8; range 1.8–3.7 mm). After PDT, mean follow-up was 56 months (median, 53; range, 14–91). Outcomes revealed complete tumor regression after 1 session (n = 3, 25%), 2 sessions (n = 3, 25%), and 3 sessions (n = 2, 17%) of PDT, reduced to mean thickness of 2.1 mm (median, 2.0; range 1.2–3.4 mm). Tumors that failed to regress (n = 4, 33%) were further controlled with transpupillary thermotherapy (n = 1) or plaque brachytherapy (n = 3). Subretinal fluid, present in six eyes, demonstrated resolution (n = 5) or progression (n = 1), and one tumor developed new subretinal fluid after PDT (n = 1). Visual outcome was stable (n = 11 eyes) or improved (n = 1). Photodynamic therapy complications included local retina pigment epithelium atrophy at the site of treatment in 3 (25%) eyes, with no effect on macular or optic nerve function.

Conclusion: Primary PDT resulted in complete tumor regression of small amelanotic choroidal melanoma in 67% at mean 5 years, with no major effect on visual acuity.

In this small case series of 12 eyes with nonpigmented or minimally pigmented small choroidal melanoma, standard-fluence photodynamic therapy (PDT) using verteporfin was effective in causing tumor regression in 8 eyes (67%) with no complications except local retinal pigment epithelium atrophy at the site of treatment in 3 eyes (25%).

*Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania;

Akdeniz University School of Medicine, Antalya, Turkey; and

Yale University School of Medicine, New Haven, Connecticut.

Reprint requests: Arman Mashayekhi, MD, Wills Eye Hospital, Oncology Service, 840 Walnut Street, Suite 1440, Philadelphia, PA 19107; e-mail: arman@shields.md

Supported by the Eye Tumor Research Foundation, Philadelphia (C. L. Shields and J. A. Shields) and Mellon Charitable Giving from the Martha W. Rogers Charitable Trust (C. L. Shields).

None of the authors has any financial/conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.