Local resection of uveal melanoma

Abstract

Local resection of uveal melanoma is aimed at conserving the eye and useful vision while removing any threat of metastatic spread. The tumour can be removed en bloc through a scleral opening (i.e., 'exoresection') or in a piecemeal fashion with a vitreous cutter passed through the retina (i.e., 'endoresection'). Variations of exoresection include iridectomy, iridocyclectomy, cyclochoroidectomy, and choroidectomy. Endoresection can be performed through a retinotomy or under a large retinal flap. Both exoresection and endoresection can be undertaken as a primary procedure, or after other conservative therapy as treatment for recurrent or toxic tumour. Each can be performed in combination with some form of radiotherapy, which can precede or follow the surgical resection. Endoresection should be relatively straightforward for experienced vitreoretinal surgeons; however, exoresection is more challenging, particularly with large and posterior tumours, because of the need for hypotensive anaesthesia and other measures to control intra-operative haemorrhage. In addition to their technical complexities, exoresection and endoresection are limited by intuitive concerns regarding iatrogenic tumour dissemination. When these obstacles are overcome, local resection preserves eyes that would otherwise be inoperable and produces relatively large tumour samples, which are useful for prognostication and research and which may one day have therapeutic value.