title: Primary transpupillary thermotherapy for 18 small posterior pole uveal melanomas.
abstract: OBJECTIVE
  To evaluate transpupillary thermotherapy (TTT) for the treatment of small uveal melanomas of the posterior pole.
  
  
  METHODS
  Prospective, nonrandomized interventional case series.
  
  
  METHODS
  Eighteen patients underwent TTT for small uveal melanomas located in the posterior pole of the eyes. Tumors were between 2.5 and 4 mm in thickness. TTT was performed with a diode laser at 810 nm. Patients had between one and three TTT sessions, with an intensity adapted to the coloration of the fundus impact. Biomicroscopic examination, ultrasonographic measurements, and angiography were performed before and two months, four months, and six months after treatment, then regularly during follow-up.
  
  
  RESULTS
  Eight of the 18 tumors regressed and 10 recurred. The one- and two-year metastasis-free survival rates calculated by the Kaplan-Meier method were, respectively, 61.11% to 44.44% (95% confidence interval). Recurrences were managed with enucleation (three patients), proton beam therapy (six), or additional thermotherapy (one). After treatment, visual acuity was maintained or improved for the eight patients with nonrecurrent tumors. Pathologic analysis of the three enucleated eyes revealed scleral invasion.
  
  
  CONCLUSIONS
  Despite encouraging initial short-term results obtained with TTT for the management of small choroidal melanomas, the occurrence of severe complications, especially recurrences and insufficient local tumor control, should raise concern about indications for primary TTT given as isolated treatment for small melanomas of the posterior pole.
authors: Department of Ophthalmology, Croix-Rousse Hospital, EA 3090, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France. myriamspire@aol.com
authors: Myriam
authors: M
authors: Spire
authors: Mojgan Shishe-Boran
authors: MS
authors: Devouassoux
authors: Laurent
authors: L
authors: Kodjikian
authors: Helène
authors: H
authors: Janin-Magnificat
authors: Jacques
authors: J
authors: Fleury
authors: Jean-Daniel
authors: JD
authors: Grange