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Relevance. Endovitreal resection (EVR) of choroidal melanoma (CM) is presented in international sources as a method that improves patient treatment outcomes. Purpos. To evaluate the first treatment outcomes for patients with CM after radiation therapy (RT) using EVR via the vitreoretinal approach. Material and methods. Study group included 21 patients with CM (ICD-10 C69.3). EVAR was performed from 01.2023 to 12.2024. Age: from 35 to 77 years (59.2±10.3). There were 8 men and 13 women. The tumor prevalence was cT1–T4 M0N0. In all cases, the tumor was localized beyond the equatorial zone of the eye. The tumor dimensions before RT were: base diameter — 10.3±4.2 mm, thickness — 5.3±2.6 mm, and before EVAR — 8.9±2.9 and 4.5±2.4 mm, respectively. EVAR of the tumor was performed when the tumor was stabilized during the observation period after RT (BT+SRS) from 4 to 84 (26.5±19.4) months. EVR was performed using the Bausch & Lomb Stellaris PC combined operating system, three-port access of 23 G (8 surgeries) and 23 G (15 surgeries): closed subtotal vitrectomy (CVE), tumor endoresection with sampling of material for cytological examination, endolaser coagulation of the retina, and, if indicated, tamponade of the vitreous cavity with silicone oil. The observation period after tumor endoresection was 8.8±2.8 months. Results. No intraoperative or early postoperative complications were observed. Silicone oil extrusion was performed in six patients after 5 months. Three patients underwent phacoemulsification with intraocular lens implantation in the period from 1 to 9 months after surgery due to the development of lens opacity; one patient underwent filtering surgery for hypotensive purposes, as indicated. Enucleation of the eyeball was performed in one patient (4.7%), 55 years old, with MC at T3N0M0, stage II, 9 months after SRS and endoresection due to the development of uncompensated secondary glaucoma. All patients are alive, no progression of the tumor process was revealed according to the results of examinations during the observation period of 8.8±2.8 months after EVAR. Conclusion. Endovitreal resection of CM can be used after RT in patients with a risk of organ loss due to complications of the tumor process («toxic tumor syndrome», prolonged absence of tumor resorption with the risk of developing continued growth).

Purpos. To conduct a comparative analysis of the local tumor control, local and systemic safety of primary endoresection (ER) of «large» choroidal melanoma (CM) compared to brachytherapy (BT) with Ru-106 in statistically homogeneous groups. Material and methods. A total of 35 patients (35 eyes) aged 30 to 75 years (mean — 58 years) with CM were treated with primary ER from 2014 to 2024. Among them, there were 9 (26%) women and 25 (74%) men. According to the international TNM classification (AJCC) (2017), 11 (31%) patients had tumors classified as stage T3, while 24 (69%) had stage T2. No metastases of CM were detected in any patient at the time of treatment. The tumor thickness before treatment ranged from 6.0 to 11.6 mm (mean — 8.2 mm), the largest basal diameter varied from 7.8 to 13.9 mm (mean — 11 mm). A comparative analysis of ER and BT was conducted in two independent groups, which were standardized by the main clinical characteristics: age at the time of treatment, preoperative best-corrected visual acuity, tumor thickness and basal diameter, tumor location, and the follow-up. Results. The comparative analysis of local tumor control did not reveal statistically significant difference (p=0.45). In the ER group, the surgical chorioretinal coloboma without tumor recurrence was observed in 33 patients (94%), tumor recurrence was identified in 2 cases (6%). In the BT group complete tumor regression was observed in 14% of cases, incomplete regression in 75%, and tumor progression in 11%. 23% of patients underwent adjuvant treatment after BT (either repeated BT or transpupillary thermotherapy). The comparative analysis of complication rates (cataract, retino-/maculopathy, neuropathy/partial optic nerve atrophy, retinal detachment, vitreous hemorrhage, secondary glaucoma) after primary ER and BT with Ru-106 did not demonstrate statistically significant difference: complications occurred in 62% of the ER group and in 59% - in the BT group (p=0.93). However, there was a trend towards a statistically significantly lower frequency of all complications except cataract after ER compared to BT (p=0.08). Conclusion. Thus, the comparative analysis in statistically homogeneous groups demonstrated that primary ER of CM is a highly effective approach for the treatment of «large» CM that is comparable to BT in local tumor control and does not increase the risk of enucleation or metastasis in comparable groups. The results suggest that primary ER for CM can be widely used in clinical practice for the treatment of «large» CM.

Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.

The exact pathogenesis of vasoproliferative tumors remains completely unknown, and it has long been assumed that their development is a reactive process with the proliferation of glial cells and blood vessels. Despite the widespread use of this term, vasoproliferative tumor cannot be fully attributed to true tumors and it cannot be reliably established that it is vascular in its pathogenesis. The clinical signs of vasoproliferative retinal tumor manifests itself as a yellowish-red, often loose mass with vessels of normal or slightly enlarged caliber, usually small, single and located in the lower-outer or lower part of the fundus. Due to their rarity, there are currently no uniform recommendations for the diagnosis and treatment of this pathology. Most of the available methods have limited effectiveness, causing a temporary regression of the process, which makes it necessary to repeatedly re-treat or combine several treatments. In some cases, the use of several therapeutic options leads to complications that can be caused by both therapy and the natural progression of the disease, which together prevents reconvalescence and improvement of visual func tions.Purpose. This article presents for the first time a detailed review of the literature, including generalized data on the epidemiology, pathogenesis, histological features, differential diagnosis and modern approaches to the treatment of this pathology.Material and methods. The article uses literary materials of domestic and foreign authors published in the period from 1982 to the present.Conclusion. It is necessary to further study the mechanisms of development of vasoproliferative tumors and related complications.

Background and Objectives: Here, we report the anatomical and functional outcomes of Pars Plana Vitrectomy (PPV) with feeder vessel ligation, with or without endoresection in cases of retinal detachment (RD) secondary to retinal capillary hemangioblastoma (RCH). Materials and Methods: This retrospective observational study included 12 eyes with RD secondary to RCH. Based on the location of the lesion and the features of the RD, eyes were divided into two groups. Seven eyes with RCH located in Zone 2 or Zone 3, associated with tractional retinal detachment (TRD), underwent PPV with feeder vessel ligation and tumor endoresection. Five eyes, either with RCH in Zone 2 or Zone 3 associated with exudative retinal detachment or with RCH in Zone 1 associated with RD, underwent PPV with feeder vessel ligation alone, without tumor endoresection. Outcome measures included local tumor control, best-corrected visual acuity (BCVA), anatomical success, and rates of complications. Results: RCH regressed completely in 100% of eyes with no evidence of recurrence. The mean follow-up was 4.6 years. In the endoresection group, the mean BCVA was 2.18 ± 0.3 logMAR at baseline and 0.95 ± 0.5 logMAR after surgery (p = 0.018), whereas in the second group, the baseline mean BCVA was 1.33 ± 0.2 logMAR and 1.52 ± 0.7 logMAR postoperatively. In the first group, retinal attachment was achieved in all eyes, whereas in the second group, two eyes presented with persistent RD and proliferative vitreoretinopathy (PVR). No cases of phthisis bulbi or neovascular glaucoma were observed. Conclusions: PPV combined with feeder vessel ligation and endoresection appears to be an effective treatment for TRD secondary to RCH located in Zones 2 and 3, providing satisfactory anatomical and visual outcomes considering the severity of the disease. In cases where tumor location precludes endoresection, PPV with feeder vessel ligation alone may still be a viable option, although the potential risk of PVR could persist.

Intraocular surgery is tabooed in retinoblastoma management, due to the concern of lethal extraocular spread. We reviewed the outcomes of consecutive children with intraocular retinoblastoma diagnosed at 29 Chinese centers between 2012–2014. We compared the outcomes of three categories of treatment: eye salvage including tylectomy (Group I), eye salvage without tylectomy (Group II), and primary enucleation (Group III). A total of 960 patients (1243 eyes) were diagnosed: 256 in Group I, 370 in Group II, and 293 in Group III; 41 patients abandoned treatment upfront. The estimated 5-year overall survivals (OS) were, for Group I, 94%, for Group II 89%, and for Group III 95%. The estimated 5-year disease-specific survivals (DSS) were, for Group I, 96%, for Group II 90%, and for Group III 95%. Patients in Group I had a significantly higher 5-year DSS than patients in Group II (p = 0.003) and not significantly different than patients in Group III (p = 0.367). Overall survival was not compromised by the inclusion of tylectomy in eye salvage therapy compared to eye salvage without tylectomy or primary enucleation. Disease-specific survival was better when tylectomy was included in eye salvage treatments. Tylectomy as part of multimodal treatment may contribute to the care of retinoblastoma patients with chemotherapy-resistant tumor, eyes with concomitant ocular complications, or at the risk of treatment abandonment.

The main objective of this prospective observational study was the characterization of the feasibility and early outcome of image-guided (IG) volumetric modulated arc (VMAT) radiosurgery (SRS) followed by resection for patients with large intraocular melanoma. Our study included consecutive patients with unfavorable-risk melanoma, enrolled in an ophthalmic oncology center. IG-VMAT-SRS was applied by high-resolution 4D image guidance and monitoring. Current stereotactic technique parameters were evaluated for comparison. Side effects and eye function, based on a 5-point CTC assessment score, were quantified. In patients with tumors located more than 0.7–1 mm apart from the optic nerve, partial to complete volume-sparing of the optic nerve head could be achieved. In 95.5% of this subgroup, the vitality of the optic nerve and vision could be preserved by the multimodality-treatment approach (mean follow-up: 18 months (7.5–36 months)). The advanced technology of stereotactic radiotherapy demonstrated the achievability of steep dose gradients around the high-dose volume, with 4D-IG-VMAT dose application. These results enforce IG-VMAT-SRS followed by resection as one of the major therapeutic options for patients with large intraocular melanoma. The combination of 4D-IG high-precision SRS and resection provides an effective treatment for large intraocular melanoma, with few side effects, and enables an eye bulb and even vision preserving modus operandi.

This study compared the cytogenetic profiles of choroidal melanoma samples retrieved before and after proton beam irradiation. Twenty-four consecutive patients who underwent both fine-needle aspiration biopsy (FNAB) during tantalum clip positioning, and endoresection within three months of irradiation, were retrospectively included. Chromosome alterations were explored by array comparative genomic hybridization. Age at diagnosis was 50 ± 14 years, tumor thickness was 8.6 ± 1.7 mm and tumor diameter was 12.4 ± 2.3 mm. Six FNAB samples were non-contributive (25%), versus one endoresection sample (4%) (p = 0.049). Among 17 cases with paired contributive samples, the profiles of chromosomes 3 and 8 were identical in all cases, except one with partial chromosome 3 loss on the FNAB sample only. Three cases presented additional discordant aberrations on chromosomes other than 3 or 8q. Overall, we identified monosomy 3 in two cases, 8q gain in six cases, and both alterations in three cases. All cases presented GNAQ or GNA11 mutations assessed by a custom next-generation sequencing panel. Among the six cases with non-contributive initial FNAB, three cases presented abnormal 3 or 8q chromosomes detected on the endoresection material. These results demonstrate the higher rentability of endoresection material for cytogenetic analysis compared to FNAB, and provide clinical evidence of tumor heterogeneity in choroidal melanoma.

Purpose: To evaluate the anatomical and functional outcomes of endoresection and adjuvant ruthenium (Ru)-106 brachytherapy for uveal melanoma (UM). Methods: Retrospective case series of 15 UM patients (15 eyes) treated at our center (Careggi University Hospital, Florence). Results: Six patients (40%) were male and nine were female (60%). The mean age of patients at the time of treatment was 61.6 years (±18.47). The mean BCVA at baseline was 20/76. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.20 mm (±2.01), and the mean largest basal diameter was 11.24 mm (±2.20). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while four patients (26.7%) were treated with a “salvage endoresection” after primary treatment failure (previous radiation treatment). The mean follow-up time was 29.9 months (±10.6). Thirteen out of fifteen patients were alive and showed no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case, the patient underwent enucleation for disease recurrence. The overall survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/70. Treatment was well tolerated, without significant complications. Conclusions: Endoresection and adjuvant Ru-106 brachytherapy is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It can control melanoma and avoid enucleation, reduce radiation-related complications, and provide tumor tissue for chromosomal analysis and prognostic testing.

Background This study aimed to determine the efficacy and complications of intravitreal chemotherapy-assisted endoresection for refractory International Classification of Retinoblastoma (ICRB) group D retinoblastoma in monocular patients. Methods In this retrospective case series, intravitreal chemotherapy-assisted endoresection by pars plana vitrectomy was performed in 11 eyes with refractory ICRB group D retinoblastoma unresponsive to standard therapies in monocular patients. Results Across a mean follow-up period of 42.7 months, globe salvage was attained in all 11 eyes (100%). There were no cases of extra-ocular tumour seeding or remote metastasis. In 9 eyes (81.8%), tumour control was achieved with one pars plana vitrectomy; in 2 cases (18.2%), repeated treatment, such as laser therapy, intravitreal chemotherapy or a second pars plana vitrectomy, was needed. Retinal reattachment was achieved in all 4 eyes (100%) with previous retinal detachment. Four eyes (36.4%) required subsequent cataract surgery due to secondary cataract. Ten eyes (90.9%) had improvement in best-corrected visual acuity at the last follow-up. Conclusion Intravitreal chemotherapy-assisted endoresection appears to be a safe and effective globe-salvaging method for refractory group D retinoblastoma. It is a promising alternative to enucleation and a supplementary therapeutic strategy for those unresponsive to standard therapies, especially for the monocular retinoblastoma patients.