[Long-term follow-up 10 years after transpupillary thermotherapy (TTT) for small, posterior located malignant melanomas of the choroid]. / Langzeitverlauf 10 Jahre nach transpupillarer Thermotherapie (TTT) kleiner, posteriorer maligner Aderhautmelanome.

BACKGROUND: The aim of this study was to evaluate the long-term results of transpupillary thermotherapy (TTT) for small malignant choroidal melanomas. PATIENTS AND METHODS: In the time period 1/1998 to 10/1999 in a prospective non-randomised analysis 26 eyes with small malignant melanomas (located posterior to the equator with base ≤ 12 and thickness ≤ 4.5 mm) were primary treated with the TTT standard protocol (follow-up over a time span of at least 10 years). RESULTS: Thirteen women and thirteen men (mean age: 64 years) underwent TTT. The mean preoperative tumour thickness was 2.45 mm (0.8 - 4.5 mm). Ten years postoperatively tumour regression without recurrence after 1.4 treatment sessions (mean) was achieved in 16 / 26 eyes, primary regression followed by tumour regrowth in 6 / 26 eyes, and primary failure of tumour regression in 4 / 26 eyes. Two patients died on liver metastasis. Ocular complications (with preference in posterior tumours after multiple TTT sessions) were observed in 14 eyes: macular pucker in 8, macular oedema in 6, choroidal neovascularisation in 4 and posterior synechia with iris atrophy in one eye. CONCLUSIONS: Choroidal melanomas treated with TTT as a stand-alone procedure need a close monitoring since these tumours developed a significant rate of local recurrences and ocular side-effects in the long run.

[Tumor regression in malignant choroidal melanomas after transpupillary thermotherapy (TTT) versus ruthenium brachytherapy and sandwich therapy - a comparative analysis]. / Tumorregression maligner Aderhautmelanome nach Transpupillarer Thermotherapie (TTT) versus Ruthenium-Brachytherapie und Sandwichtherapie - eine vergleichende Analyse.

PURPOSE: The aim of this study was to evaluate tumour regression in a large series of choroidal melanomas, which were treated with three different eye-sparing treatment modalities. PATIENTS AND METHODS: Retrospective review of the treatment results in all eyes with malignant choroidal melanoma, which were treated in the University Eye Clinic of Mainz consecutively in the time span 1.1992 to 12.2000 with transpupillary thermotherapy (TTT, standard protocol Oosterhuis JA 1995), ruthenium brachytherapy (RB, tumor apex dose 150 Gy) or sandwich therapy (ST). One-step ST was defined as TTT followed by RB with 100 Gy tumor apex dose within 48 hours. The treatment of residual prominences with TTT secondary to RB after different time spans was called two-step ST. Follow-up was 2 years. RESULTS: 131 eyes with malignant choroidal melanoma (mean tumour thickness: 4.5 mm) were treated with RB (66 eyes), TTT (26 eyes) or ST (39 eyes). Preservation of the globe was achieved in 109 eyes (81 %). Local tumour control was found in small melanomas (prominence up to 3 mm) in 89 %, in large tumors (prominence 8 mm and higher) in 50 %. In a subgroup of small posterior melanomas (n = 70 eyes, prominence up to 4.5 mm, located posterior to the equator) local tumour control was noted in 91 %. The time span to reach local tumour control (Kaplan-Meier estimates) was the shortest after TTT (median: 20 weeks), compared with RB (48 weeks) and one-step ST (29 weeks). CONCLUSIONS: In choroidal melanomas the chance of local tumour control and preservation of the globe decreases with increase of the tumour prominence. In small choroidal melanomas with posterior location local tumour control was achieved significantly faster after TTT than after RB.

[Tumor regression and visual outcome after transpupillary thermotherapy (TTT) for malignant choroidal melanoma]. / Morphologische und funktionelle Ergebnisse nach transpupillarer Thermotherapie (TTT) maligner Aderhautmelanome.

BACKGROUND: The aim of this study was to evaluate the course of tumor regression and visual impairment in choroidal melanomas treated by transpupillary thermotherapy (TTT) alone. PATIENTS AND METHODS: In a prospective, non-randomized analysis 26 patients suffering from primary choroidal melanoma (posterior to the equator with base < or = 12 and thickness < or = 4.5 mm) were treated with the TTT standard protocol and followed for 33 - 45 months. Fluorescein and ICG angiographies were performed initially and after tumor regression clinically. RESULTS: 22 tumors were significantly flattened after 1 - 3 TTT sessions. 4 tumors required additional therapy with ruthenium plaque. Visual acuity remained unchanged or improved in 11 eyes. In all eyes fluorescein and indocyanine green angiography revealed a sharp demarcation of the heat-treated area. Except for macular edema and gliosis in 6 eyes no vascular or retinal tissue damage was noticed outside the treatment zone. In the periphery of the treatment zone all eyes showed residual choriocapillaries remaining perfused. During follow-up 2 eyes revealed tumor regrowth at the posterior margin of the scar, which was successfully managed by TTT or a ruthenium plaque. 2 eyes developed late choroidal neovascularizations (CNV) in the heat-treated area. One patient died of liver metastases. CONCLUSIONS: Fluorescein and indocyanine green angiographic findings after TTT for small choroidal melanomas suggest that the tissue damage in the choroidal layer is less effective, which perhaps can lead to a higher rate of tumor regrowth. Development of choroidal neovascularization may be a sign of late heat-induced side effects of TTT.

[Kinetics of indocyanine green (ICG) and clinical use for enhancement of transpupillary thermotherapy (TTT) in hypopigmented small choroidal melanomas]. / Kinetik von Indozyaningrün (ICG) und adjuvanter Einsatz zur transpupillaren Thermotherapie (TTT) pigmentarmer kleiner Aderhautmelanome.

BACKGROUND: To determine the efficacy of intravenous indocyanine green (ICG) as an adjuvant to TTT for hypopigmented choroidal melanomas. PATIENTS AND METHODS: ICG kinetics in melanoma tissue were evaluated by taking standardized ICG angiograms in 28 eyes with small choroidal melanomas. In a prospective non-randomized analysis 12 eyes with hypopigmented choroidal melanomas (posterior to the equator with thickness

Primary transpupillary thermotherapy (TTT) for malignant choroidal melanoma.

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) as the only method of treatment for small choroidal melanoma. PATIENTS AND METHODS: In a prospective non-randomized analysis, 20 patients with primary choroidal melanoma (posterior to the equator with base < or = 2 and thickness < or = 4.5 mm) were treated with TTT as the only method of treatment (diode laser at 810 nm, beam diameter 3 mm, power setting 0.3-0.9 W, exposure time 20-37 min). During follow-up of at least 6 months, clinical aspects, ultrasonographic tumour thickness, fluorescein and indocyanine green angiographic patterns, visual acuity and ocular side-effects were recorded. RESULTS: In 17 eyes the tumour regressed significantly within 3 months after one treatment session (to a flat chorioretinal scar in 15 eyes). Despite a clinically flattened chorioretinal scar, fluorescein and indocyanine green angiography revealed that choriocapillary vessels in the heat-treated areas of 15 eyes remained perfused. Three amelanotic melanomas showed almost no response to TTT after repeated treatment at higher power settings. Visual acuity remained unchanged or improved in 12 eyes. Ocular side-effects included posterior synechia of the iris (1), macular oedema (2) and temporary retrobulbar pain (2). No patient showed tumour recurrence or metastases during follow-up. CONCLUSIONS: Preliminary results obtained by this study demonstrate good efficacy and visual outcome following TTT as the only method of treatment for small choroidal melanoma. However, indocyanine green angiographic findings suggest that tissue damage in the choroidal layer might be less effective, which perhaps may lead to a higher rate of tumour regrowth. Long-term follow-up is required to obtain data on late ocular side-effects, tumour recurrence and metastasis.