Combined photodynamic therapy and transpupillary thermotherapy for small choroidal melanoma

The objective of this study was to determine whether combining verteporfin-based photodynamic therapy (PDT) and transpupillary thermotherapy (TTT) achieves adequate tumour control while maintaining visual acuity in individuals with small choroidal melanoma of amelanotic, melanotic, and variable pigmentation. Individuals with posterior choroidal melanomas up to 3 mm in height underwent verteporfin-based PDT followed by immediate TTT. Further combined laser therapy was performed if a poor response was noted at 12 weeks or beyond. Tumours that demonstrated significant further growth were treated with brachytherapy or enucleation. A total of 37 eyes of 37 patients from the Terrace Eye Centre in Brisbane, Australia were studied. Average age of participants was 59.62 ± 12.45 years, and 17 of 37 participants were female (46%). This was a retrospective, noncomparative interventional study. Seven of the 37 participants (19%) had recurrence of their tumour requiring further brachytherapy or enucleation. There was no statistically significant difference in visual acuity before and after treatment. There were no baseline characteristics that predicted treatment outcome. Ten individuals developed complications including epiretinal membrane (16%), scotoma (8%), cataract (3%), and macular edema (3%). No individuals experienced extraocular extension or progressed to metastatic disease. The mean follow-up time was 49 months. Combined PDT and TTT achieved 81% tumour control in this study while preserving visual acuity. However, higher rates of local recurrence compared with brachytherapy warrant close follow-up to identify recurrences early. La présente étude avait pour objectif de déterminer si l'association de la thérapie photodynamique (TPD) à la vertéporfine et de la thermothérapie transpupillaire (TTT) donne lieu à une maîtrise adéquate de la tumeur tout en permettant de conserver l'acuité visuelle en présence de petits mélanomes choroïdiens amélanotiques, mélanotiques ou à pigmentation variable. Étude d'intervention non comparative rétrospective. Des patients présentant un mélanome de la choroïde postérieure d'au plus 3 mm de hauteur ont fait l'objet d'une TPD à la vertéporfine immédiatement suivie d'une TTT. Une autre séance de double traitement au laser a eu lieu en cas de réponse médiocre après 12 semaines et au-delà. À cette étape, les tumeurs dont la croissance était significative ont été traitées par brachythérapie ou énucléation. On a ainsi étudié 37 yeux de 37