gms | German Medical Science

To evaluate efficiency of TSTT in separate and combined treatment of choroidal melanoma (CM).

19 patients with CM (tumor thickness was 4-12 mm with tumor diameter 7-17 mm) were treated by means of TSTT as a primary method. Diode laser “Alcom-medica” (St.-Petersburg) with 0.81 mkm wavelength, equipped with patented curved “side-focus”delivery system was used. After aiming by laser-pilot, long-exposures (60-90 second) were applied in overlapping technique on 500-700 mW power.

Two groups of patients were analyzed in 5-1 years follow-up period after near-infrared-laser TSTT. In first group (n=11) TSTT was the main treatment, but TTT was added in 7 cases. In second group (n=8) tumor endoresection and vitreoretinal surgery was performed in two weeks after TSTT.

Immediate reaction after TSTT was paling and swelling of tumor, increasing of exudation and different level of hemorrhages. In first group atrophic scar was achieved after 3 – 12 months of follow-up. In second group endoresection passed presumably without bleeding, white scleral sector of eye fundus can be observed soon after surgery. There were no metastasis in both groups, one enucleation was performed after endoresection due to PVR progression and eye phthisis. Visual outcomes were satisfactory and depends above all on tumor localization, size. Poor vision was related with optic nerve damage in second group (2 cases). Cosmetic results were good.

TSTT can be effectively applied in as self-dependent method in CM with up to 4-5 mm thickness. In large-thickness tumors it can be used as primary treatment with subsequent TTT, or as preparing for tumor endoresection. The main contraindication for TSTT is spread tumor contact with optic head.