Evaluation of the effectiveness of organ preservation treatment of choroidal melanomas by optical coherence tomography findings

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Achieving local tumor control is generally considered to be the criterion of effectiveness of organ preservation treatment. In most cases it can be assessed by ophthalmoscopy and ultrasonography. However, in presence of pigmentation areas, it can be difficult to interpret the ophthalmoscopy and ultrasonography findings. The works concerning the informativity of optical coherence tomography (OCT) after organ preservation treatment of choroidal melanomas (CM) generally cover the complications (post-radiation maculopathy, neuropathy) and the identification of vitreomacular tractions. In evaluation of local control, attention is paid to the presence of subretinal fluid and/or retinal pigment epithelium (RPE) detachment.

PURPOSE

To analyze OCT findings in terms of the condition of eye fundus tissues in various outcomes of organ preservation treatment of CM.

MATERIAL AND METHODS

The study included 20 patients (20 eyes) who underwent the following organ preservation therapy 1 to 374 months prior to enrollment: transpupillary thermotherapy (TTT) — 8 eyes, brachytherapy (BT) — 8 eyes, BT with subsequent TTT — 4 eyes. Mean age of patients at the time of therapy start was 59.25±10.86 (33-81) years. In multi-step therapy (12 eyes), the mean interval between the stages was 28.08±20.39 months. According to echobiometry findings, tumor prominence at the time of therapy start was 3.35±2.08 (1—7.37) mm. At the time of post-treatment OCT scan, there was no prominence in 5 eyes, in other eyes it was 1.26±1.24 (0.4—5.7) mm.

RESULTS

Comparison of ophthalmoscopy picture with OCT findings allowed identification of the following changes: a scar and hyperplasia of pigment epithelium in the scar, a scar with reactive pigment hyperplasia at the level of RPE and choroid, radioreaction, growth area from under and inside the scar, incomplete local control, absence of local control.

CONCLUSION

The author's own expertise in evaluating the effectiveness of local choroidal melanoma therapy suggests that optical coherence tomography should be used to monitor all patients being followed up after organ preservation treatment of choroidal melanoma: after transpupillary thermotherapy — for 3 months, after brachytherapy — during first 24 months, and in case of doubts for longer.

Keywords:

organ preservation treatment of choroidal melanoma

local control

optical coherence tomography

Authors:

Stoyukhina A.S.

Krasnov Research Institute of Eye Diseases

ORCID: 0000-0002-4517-0324

Received:

10.03.2021

Accepted:

21.04.2021

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