title: Trans-scleral local resection of toxic choroidal melanoma after proton beam radiotherapy.
abstract: OBJECTIVE
  To report on trans-scleral local resection of choroidal melanoma for exudative retinal detachment and neovascular glaucoma (toxic tumour syndrome) after proton beam radiotherapy (PBR).
  
  
  METHODS
  A non-randomised, prospective study of secondary trans-scleral local resection of choroidal melanoma for exudative retinal detachment with or without neovascular glaucoma after PBR. The patients were treated at the Liverpool Ocular Oncology Centre between February 2000 and April 2008. The trans-scleral local resection was performed with a lamellar-scleral flap, using systemic hypotension to reduce haemorrhage.
  
  
  RESULTS
  12 patients (six women, six men) with a mean age of 51 years (range 20-75) were included in this study. The tumour margins extended anterior to ora serrata in six patients. On ultrasonography, the largest basal tumour dimension averaged 12.4 mm (range 6.8-18.1) and the tumour height averaged 7.1 mm (range 4.2-10.7). The retinal detachment was total in seven patients. Neovascular glaucoma was present in four patients. The time between PBR and local resection had a mean of 17.4 months (range 1-84). The ophthalmic follow-up time after the local resection had a mean of 46.2 months (range 14-99). At the latest known status, the eye was conserved in 10 patients, with a flat retina in all these patients and visual acuity equal or better than 6/30 in four patients. The reasons for enucleation were: patient request for enucleation when rhegmatogenous retinal detachment complicated the resection (one patient) and phthisis (one patient).
  
  
  CONCLUSIONS
  Exudative retinal detachment, rubeosis and neovascular glaucoma after PBR of a choroidal melanoma can resolve after trans-scleral local resection of the tumour. Our findings suggest that these complications are caused by the persistence of the irradiated tumour within the eye ('toxic tumour syndrome').
authors.affiliation: Vitreoretinal and Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Lazaros
authors.initials: L
authors.lastname: Konstantinidis
authors.affiliation: Vitreoretinal and Ocular Oncology Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Groenewald
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Coupland
authors.affiliation: Ocular Oncology Service, University of California, San Francisco, California, USA.
authors.forename: Bertil
authors.initials: B
authors.lastname: Damato
mesh_terms: D000328:Adult; D000368:Aged; D002830:Choroid Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery*; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D015355:Glaucoma, Neovascular / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D008545:Melanoma / Q000000981:diagnostic imaging / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D011446:Prospective Studies; D061766:Proton Therapy / Q000009:adverse effects*; D012163:Retinal Detachment / Q000209:etiology / Q000503:physiopathology*; D012590:Sclera / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult
keywords: Choroid; Neoplasia; Treatment Surgery