title: Tumor volume reduction using combined phacoemulsification and intravitreal triamcinolone injection for the management of cataract with treated uveal melanoma and atypical nevi.
abstract: OBJECTIVE
  To study the reduction in tumor size and the safety and efficacy of combined phacoemulsification and intravitreal triamcinolone acetonide injection (phaco-IVTA) in patients with treated melanoma and atypical nevi.
  
  
  METHODS
  Bascom Palmer Eye Institute, Miami, Florida, USA.
  
  
  METHODS
  The medical records of 49 consecutive patients (51 eyes) with treated melanoma or atypical nevi treated with phaco-IVTA were evaluated retrospectively for changes in Snellen visual acuity, tumor volume, and frequency of complications. Main outcome measures included a postsurgical change in tumor size greater than or equal to 0.5 mm of height or 1.0 mm of basal diameter by echographic analysis, improvement in visual acuity at 6 months and final follow-up, and complications including endophthalmitis, cystoid macular edema, epiretinal membrane, increased intraocular pressure, and persistent corneal edema.
  
  
  RESULTS
  The median baseline visual acuity was 20/80 in the affected eye. At the 6-month follow-up examination, 13 (68%) of 19 eyes had achieved better than 20/40 visual acuity. Treated uveal melanomas (n=30) and atypical choroidal nevi (n=21) were stable with combined therapy, and echographic measurements improved in 12 eyes. Intraocular pressure increased from baseline to 25 mm Hg or more postoperatively in 4 of 51 eyes (8%). No other significant complications occurred.
  
  
  CONCLUSIONS
  Combined phacoemulsification and IVTA was reasonably safe in patients with treated melanoma and atypical nevi. Tumors remained stable or decreased slightly in size. Intravitreal triamcinolone acetonide injection at the time of cataract surgery in patients with treated melanoma or nevus may reduce rates of tumor progression in these patients.
authors.affiliation: Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami Miller School of Medicine, Miami, Florida 33101, USA.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Cebulla
authors.forename: Armando M
authors.initials: AM
authors.lastname: Alegret
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.forename: Wei
authors.initials: W
authors.lastname: Shi
authors.forename: Amy C
authors.initials: AC
authors.lastname: Schefler
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007267:Injections; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000473:pathology*; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000000981:diagnostic imaging / Q000473:pathology*; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D047368:Tumor Burden; D014463:Ultrasonography; D014604:Uveal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014792:Visual Acuity / Q000502:physiology; D014822:Vitreous Body
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide