Review

Authors: Hany S Hamza, Abdelrahman M Elhusseiny

Uveal melanoma is the most common intraocular malignant tumor, with the choroid being the most common site. Management of choroidal melanoma has evolved greatly over the past years. In the past, the conventional method of treatment was enucleation of the affected eye with a debate regarding the effect of enucleation to promote or prevent metastasis. However, nowadays, there are many therapeutic options available including plaque radiotherapy, proton beam radiotherapy, argon laser photocoagulation, transpupillary thermotherapy, stereotactic radiotherapy using gamma knife, enucleation, and surgical resection of the tumor whether through transscleral approach "Exoresection" or less commonly through internal resection approach "Endoresection." The indications and complications of each technique are reviewed. Although radiotherapy is the primary treatment of choroidal melanoma in most ocular oncology centers, it is used as an adjuvant therapy in combination with surgical resection. Preoperative stereotactic radiotherapy before endoresection and brachytherapy to the surgical bed in both exo and endoresection can effectively decrease the recurrence rate. In this article, we will focus on surgical resection of choroidal melanoma whether endoresection or exoresection. We collected data published in indexed journals and related books.

Topics: Choroid Neoplasms; Humans; Melanoma; Ophthalmologic Surgical Procedures

PubMed: 30122851
DOI: 10.4103/meajo.MEAJO_73_18

Authors: Michael I Seider, Bertil E Damato

Topics: Choroid Neoplasms; Female; Humans; Laser Coagulation; Melanoma; Neoplasm Recurrence, Local; Vitrectomy

PubMed: 25579369
DOI: 10.4103/0301-4738.149157

Review

Authors: C Camarillo Gómez, I Sánchez Ronco, Jl Encinas...

Uveal metastases are the most frequent malign intraocular tumour, of which more than 80% are localized in the choroids. This, together with the progressive increase in its incidence, makes its study and review necessary for a correct diagnosis and treatment in current clinical practice. Etiology varies according to the sex of the patient: lung carcinoma metastasises most frequently in men and breast carcinoma in women. These tend to multifocality and are generally localized in the posterior pole. Fifty percent of cases follow an asymptomatic development, but they can cause loss of vision, scotomas, metamorphopsias and photopsias. Charactersitic ophthamoscopic examination shows a placoid, homogenous choroidal lesion with a creamy appearance. The differential diagnosis must consider the amelanotic nevus, choroidal amelanotic melanoma, choroidal haemangioma, rear scleritis, choroidal osteoma, chorioretinitis, Harada's disease, rhegmatogenous retina detachment, uveal effusion syndrome, and serous central chorioretinopathy. An exhaustive history and complete ophthalmological examination are essential to the diagnosis, to which fluorescein angiography, ocular echography, fine needle puncture aspiration (FNPA), computerized tomography and magnetic resonance can be added as complementary tests. Treatment of these tumours is usually the systemic treatment of the primary tumour; the possibilities of local treatment are observation, external radiotherapy, transpupillary thermotherapy and enucleation.

Topics: Choroid Neoplasms; Humans

PubMed: 19169300
DOI: No ID Found

Review

Authors: Abhilasha Maheshwari, Paul T Finger

Laser treatment has offered a relatively nonsurgical alternative for eye, life, and vision-sparing treatment of malignant melanoma of the choroid. Historically, the most commonly used forms of lasers were xenon-arc, argon laser, krypton laser, and the more recent transpupillary thermotherapy (TTT) and photodynamic therapy (PDT). Melanomas selected for laser treatment tend to be smaller and visibly accessible, which means these tumors are usually located in the posterior choroid. Laser treatments have been associated with both local tumor destruction and side effects. Unlike radiation therapy, laser treatment has been commonly associated with retinal traction, hemorrhage, chorioretinal neovascularization, and extra scleral tumor extension, as well as higher rates of local treatment failure. In addition, however, laser-treatment has been successfully used to treat tumor-related retinal detachments, radiation retinopathy, and neovascular glaucoma. We review the world's experience of ophthalmic laser treatment for choroidal melanoma, offer safety and efficacy guidelines, as well as a comparison of laser treatment to radiation therapy outcomes.

Topics: Humans; Hyperthermia, Induced; Choroid Neoplasms; Choroid; Melanoma; Lasers; Uveal Melanoma

PubMed: 35644256
DOI: 10.1016/j.survophthal.2022.05.002

Authors: A LISTER, G MORGAN

Topics: Choroid; Choroid Neoplasms; Diagnosis, Differential; Hemangioendothelioma; Humans; Infant; Neoplasms; Pathology; Retinal Detachment; Retinoblastoma; Surgical Procedures, Operative

PubMed: 14188324
DOI: 10.1136/bjo.47.4.215

Review

Authors: Inês Coutinho, Tânia Teixeira, Paulo César Simões...

Choroidal melanoma is the most common primary intraocular malignant tumor in adults. None of the different treatments available offers advantages of survival, resorting more and more to conservative treatments such as brachytherapy, which has been available in Portugal since 2013. In this article we review the clinical characteristics, risk factors, diagnosis, complementary exams and therapeutic options in choroidal melanoma.

Topics: Choroid Neoplasms; Humans; Melanoma

PubMed: 28926332
DOI: 10.20344/amp.8535

Review

Authors: Sruthi Arepalli, Swathi Kaliki, Carol L Shields...

The choroid is the most common ocular site for metastatic disease, owing to abundant vascular supply. The primary cancers that most commonly lead to choroidal metastases include breast cancer (40-47%) and lung cancer (21-29%). Bilateral, multifocal metastases are most often secondary to breast cancer, whereas unilateral, unifocal metastasis are more commonly found with lung cancer. The treatment of choroidal metastasis depends on the systemic status of the patient and number, location, and laterality of the choroidal tumors. Treatment options include observation in patients with poor systemic status or those with resolved or asymptomatic disease; systemic chemotherapy, immunotherapy, hormone therapy, or whole eye radiotherapy if the metastases are active, multifocal and bilateral; plaque radiotherapy, transpupillary radiotherapy, or photodynamic therapy for active, solitary metastasis; and enucleation for those with blind painful eye. A database search was performed on PubMed, using the terms "choroidal metastasis," or "choroidal metastases," in combination with terms such as "treatment," "features," or "diagnosis." Relevant articles were extracted and reviewed.

Topics: Choroid; Choroid Neoplasms; Combined Modality Therapy; Diagnosis, Differential; Humans

PubMed: 25827542
DOI: 10.4103/0301-4738.154380

Review

Authors: P Mahesh Shanmugam, Rajesh Ramanjulu

Vascular tumors of the retina and choroid can be seen occasionally. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.

Topics: Choroid Neoplasms; Diagnosis, Differential; Disease Management; Hemangioma; Humans; Retinal Neoplasms

PubMed: 25827544
DOI: 10.4103/0301-4738.154387

Authors: Sang-Hyeok Lee, Jeong-Seok Hong, Joon-Hyuk Choi...

PURPOSE

Schwannoma is rarely encountered as an intraocular tumor arising from uveal tract. We describe a case of choroidal schwannoma.

METHODS

A 74-year-old woman presented with rapidly decreasing visual acuity and proptosis for 2 months. To further delineate the tumor, she underwent enucleation of the eyeball. The tumor was examined by light microscopy, electron microscopy and immunohistochemical study.

RESULTS

Microscopically, the tumor was composed of a mixture of cellular solid component (Antoni A) and loose myxoid component (Antoni B). Immunohistochemical study revealed a positive reaction for S-100 protein. Ultrastructurally, the tumor cells showed prominent, continuous basal lamina.

CONCLUSIONS

We enucleated the eyeball with a clinical diagnosis of choroidal amelanotic melanoma, but the tumor was finally diagnosed as schwannoma. We think that currently available ancillary studies are still little value in definitely differentiating schwannoma from other choroidal tumors.

Topics: Aged; Choroid Neoplasms; Diagnosis, Differential; Eye Enucleation; Female; Humans; Magnetic Resonance Imaging; Neurilemmoma; Ultrasonography; Visual Acuity

PubMed: 16396657
DOI: 10.1111/j.1600-0420.2005.00517.x

Review

Authors: R N Hussain, B Damato, H Heimann...

The majority of choroidal tumours are diagnosed accurately with clinical examination and the additional data obtained from non-invasive imaging techniques. Choroidal biopsies may be undertaken for diagnostic clarity in cases such as small melanocytic or indeterminate lesions, identifying the primary tumour in the case of choroidal metastases or the subclassification of rarer conditions such as uveal lymphoma. There is however an increasing use of biopsy techniques for prognostication in uveal melanoma. This review explores the main indications and surgical techniques for tumour acquisition, and the optimised approach utilised by the current authors to improve successful yield for histological and genetic analysis.

Topics: Humans; Biopsy; Uveal Neoplasms; Choroid Neoplasms; Choroid; Melanoma

PubMed: 35941182
DOI: 10.1038/s41433-022-02194-0