Background: Uveal melanoma is a highly malignant tumour of
the eye, which is characterised by melanocytic tumour growth within the uveal
tract of the eye. There is a nearly equal distribution of primary uveal
melanoma gender. The management options include transpupillary thermotherapy,
brachytherapy, stereotactic radiotherapy, limited surgical resection,
enucleation and orbital exenteration. Complications in the surgical removal of
pre-equatorial tumours are largely technique-related and may be reduced by
combining tumour resection with simultaneous vessel coagulation using radiowave
surgery.
Purpose: The aim of this study is to determine the efficacy
of resecting iris and ciliary body melanoma with the use of a 3.8-4.0-Mhz
radiowave surgery unit.
Methods: This study was carried out at the Department of Eye
Cancer, the Filatov Institute, between 2005 and 2018 and included 45 patients
with iris and ciliary body melanoma, with a mean age of 56.3 ± 2.2 years and a
slight predominance of female patients (53.3%). Sixty-seven patients who had
undergone iridociliary melanoma excision using a conventional technique with
cutting tools were used as retrospective controls. The eye examination included
visual acuity measurement, perimetry, biomicroscopy and ophthalmoscopy. Tumour,
nodus и metastasis (TNM) staging was according to the American Joint Committee
on Cancer (AJCC). No metastases were seen at the time of enrollment. The mean
tumour prominence at baseline was 4.0 ± 0.3 mm, with a mean base diameter of
8.3 ± 0.4 mm, corresponding to a tumour volume of 34.3 ± 0.7 mm3. Patients in both groups were
stratified by baseline visual acuity into two subgroups (0.1–0.5 and 0.6–0.8).
In the study group, subgroup 1A included 37 patients (82.2%) with visual acuity
of 0.1–0.5, while subgroup 1B comprised 8 patients (17.8%) with visual acuity
of 0.6–0.8, and in the retrospective control group, subgroup 2A consisted of 55
patients (82.1%) with visual acuity of 0.1–0.5, and subgroup 2B included 12
patients (17.9%) with visual acuity of 0.6–0.8 (p > 0.05). The analysis was
performed by analysis of variance (ANOVA) using Statistica 13.0 (Dell Statsoft
Inc., Austin, TX).
Results: The radiosurgical approach to treatment of
iridociliary tumours in our patients allowed significantly reducing the rates
of intraoperative and postoperative complications (χ2=4.16; df=1; p=0.04). In
addition, the rates of intraoperative and postoperative complications for the
treatment of iridociliary tumours with cutting instruments were 9.1% and 10.4%,
respectively. The use of a radiowave surgery unit for uveal melanoma resection
allowed preserving baseline visual acuity in all patients, with a tumour
recurrence rate of not more than 2.2%.
Conclusion: The use of a radiowave surgery unit for uveal
melanoma resection allowed preserving baseline visual acuity in all patients.
Early (12-month) treatment outcomes (visual functions and postoperative
clinical course) and late treatment outcomes (visual functions; optic media;
IOP; and tumour recurrence) for iridociliary melanoma resection using a
radiowave 3.8-4.0 MHz unit allow us to state that high-frequency radiowave
surgery enables reducing the risk of intraoperative and postoperative
complications and, consequently, preserving a good visual function.
Author(s) Details
Maletskyy Anatoliy
Parfentievic
Filatov Institute of Eye Diseases and Tissue Therapy, National Academy of
Medical Sciences of Ukraine, Odesa, Ukraine.
Khomiakova Olena
Victorovna
Filatov Institute of Eye Diseases and Tissue Therapy, National Academy of
Medical Sciences of Ukraine, Odesa, Ukraine.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v4/6842
