Journal Article

Endoresection of choroidal melanoma by vitreoretinal approach in patients after radiation therapy

Naumenko, L.V., Polyakov, S.L., Zhylyaeva, E.P., Holub, O.M., Krasniy, S.A., Krivun, A.O.

2025

Overview

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).