Intumescent cataract after topical mitomycin-C for conjunctival malignant melanoma

PURPOSE: To present the clinical and histologic findings of a patient in whom intumescent cataract developed after successful topical mitomycin-C (MMC) chemotherapy for conjunctival melanoma originating from primary acquired conjunctival melanosis (PAM) with atypia. DESIGN: Observational case report; follow-up at 30 months. METHODS: In a patient with PAM and subsequent conjunctival melanoma that was successfully treated with topical MMC chemotherapy an intumescent cataract developed after two cycles of 0.04% MMC, each for 1 month. RESULTS: After MMC chemotherapy pigmentation of the acquired melanosis vanished almost completely. Histopathology of the check-up specimen revealed local tumor control. Six weeks after the completion of the second cycle, an intumescent cataract developed. Cataract surgery was performed uneventfully. The patient was followed up for 30 months. CONCLUSIONS: In selected cases, topical MMC chemotherapy is effective for treating conjunctival melanoma. Although severe complications are rare and usually transient, development of cataract may be observed. A prospective study should be initiated.     

MIB-1 and PC-10 immunostaining for the assessment of proliferative activity in primary acquired melanosis without and with atypia

AIMS—To compare the proliferative activity of intraepithelial melanocytes in primary acquired melanosis (PAM) without atypia and PAM with atypia by immunohistochemical staining for the Ki-67 antigen and the proliferating cell nuclear antigen (PCNA).
METHODS—Formalin fixed, paraffin embedded sections from 35 archival specimens of PAM without atypia (n=19) and with atypia (n=16) were studied by immunostaining with MIB-1 and PC-10 monoclonal antibodies that react with the Ki-67 antigen and PCNA respectively. The results were calculated as the mean number of positive cells per eyepiece grid. All specimens were evaluated by two masked observers, and the interobserver reproducibility was assessed.
RESULTS—The means of the positive cell count in PAM with atypia were significantly higher compared with PAM without atypia for both observers, in both the PC-10 and the MIB-1 stained sections. In a linear least square model that estimated the interobserver and between group variation, the difference of MIB-1 and PC-10 positive cell count between PAM without and with atypia remained highly significant. The difference between the observers was not significant.
CONCLUSIONS—Immunostaining with MIB-1 and PC-10 demonstrated that PAM with atypia has higher proliferative activity than PAM without atypia. This method was found to be reproducible between different observers.

Keywords: primary acquired melanosis; immunostaining; atypia     

Topical mitomycin chemotherapy for conjunctival malignant melanoma and primary acquired melanosis with atypia: 12 years’ experience

Purpose To report 12-year follow-up experience with topical mitomycin chemotherapy for diffuse and multifocal primary acquired melanosis (PAM) with atypia and conjunctival melanoma. Methods Interventional case series of 16 patients. Mitomycin was a primary treatment for residual epithelial disease in ten patients (eight with PAM with atypia and two with conjunctival melanoma) and as an adjuvant to excision and cryotherapy in six with conjunctival malignant melanoma. Primary treatments consisted of mitomycin 0.04% qid for 28 days (two 14-day cycles) and for 7 consecutive days as adjuvant therapy. Patients were followed for both local recurrence and metastatic disease. Results Sixteen patients were followed for a mean 81 months (range 13–144 months) after treatment. All tumors responded to chemotherapy. Recurrence was noted in eight (three adjuvant and five primary treatment patients). Three underwent orbital exenteration. The remaining five were treated conservatively. The mean time to recurrence was 36.9 months. The short-term mitomycin-related complications included transient keratoconjunctivitis (n=14), severe keratoconjunctivitis (n=1) and one corneal abrasion with scar formation. The long-term complications included pannus (n=2) and corneal haze (n=1). Visual acuity was maintained within two lines in 14 patients (including measurements just prior to exenteration). Three patients died, one of metastatic conjunctival melanoma. Conclusions Conjunctival melanoma and PAM responded to mitomycin 0.04% topical chemotherapy; subepithelial nests appeared resistant to treatment. Treatment-related complications were acceptable. In this series, as primary and adjuvant therapy, topical mitomycin yielded an overall recurrence rate of 50%. Presented (in part) at the American Academy of Ophthalmology Annual Meeting, New Orleans, October 2004.     

Resolución de un melanoma conjuntival con interferón tópico alfa 2 b en un paciente con intolerancia a la mitomicina C

Objective

To describe the clinical and histological resolution of a case of an inexcisable conjunctival melanoma using topical interferon alpha 2 b (INFα2b) in a patient with mitomycin C (MMC) intolerance.

Topical mitomycin C in the treatment of pigmented conjunctival lesions

PURPOSE: To assess the clinical efficacy of topical mitomycin C (MMC) 0.04% for the treatment of patients with pigmented conjunctival lesions. Clinical efficacy was evaluated on the basis of reduction in lesion size and degree of pigmentation and histologic study. METHODS: Two patients, one with primary acquired conjunctival melanosis with atypia and another with conjunctival melanoma, were treated with topical MMC 0.04%. Before treatment, a biopsy was performed that confirmed the diagnosis and the absence of atypical melanocytes beyond the basal layer. In both patients, MMC was administered with sponges, while one patient additionally received MMC 0.04% drops. Each treatment cycle lasted 14 days, with repetition after 3 months when necessary. Follow-up was weekly, then monthly, and then every 6 months up to 3 years. RESULTS: Treatment with topical MMC 0.04% not only reduced the size and degree of pigmentation clinical lesions in both patients but also eradicated atypical conjunctival melanocytes as observed in histologic studies. In the patient with primary acquired conjunctival melanosis, adjunct cryotherapy was required, along with various cycles of MMC, to reduce the pigmented areas of skin of the internal canthus and caruncle. In the second case, only MMC was used. No severe adverse reactions to the treatment were observed. After 3 years of follow-up, no clinical relapse has been detected. CONCLUSION: Topical MMC 0.04% is an option worth considering for the treatment of pigmented conjunctival lesions, particularly as an adjunct to other forms of treatment.     

Primary acquired melanosis of the conjunctiva.

BACKGROUND: Primary acquired melanosis (PAM) presents as a unilateral patchy area of conjunctival pigmentation mostly found in middle-aged or elderly white patients. Because PAM has the potential of becoming malignant, it is important to recognize PAM and to rule out other causes of pigmented lesions. The presence or absence of atypia is helpful in determining the potential for malignancy, because PAM without atypia is usually benign, whereas PAM with atypia may convert into a conjunctival melanoma. If atypia is present, the presence or absence of epithelioid cells and the pattern of intraepithelial growth are the main factors in determining the likelihood of neoplastic transformation. However, atypia can only be determined with histopathologic examination. Therefore, a biopsy is usually recommended. CASE REPORT: A 72-year-old white man presented for his annual examination with no visual complaints. His ocular history was remarkable for early cataracts and for a choroidal nevus. Slit lamp examination found a large dark area of elevated conjunctival pigmentation at the medial canthus that extended onto the superior bulbar conjunctiva and superior palpebral conjunctiva in the left eye. No conjunctival pigmentation had been noted previously. Results of a biopsy indicated primary acquired melanosis with atypia. The lesion was surgically excised, and the conjunctiva was reconstructed with an amniotic membrane graft. The patient was subsequently treated with topical 5-fluorouracil chemotherapy. There have been no signs of recurrence to date after his treatment. CONCLUSION: Because of the potential for malignancy, biopsies of all cases of primary acquired melanosis are indicated. If atypia is present, treatment options include local excision, cryotherapy, and topical chemotherapy.     

The treatment of primary acquired melanosis (PAM) with atypia by topical Mitomycin C

PURPOSE: To report our results of 12 consecutive patients with conjunctival primary acquired melanosis (PAM) with atypia who were treated by topical Mitomycin C (MMC). DESIGN: Retrospective interventional consecutive case series. METHODS: Twelve patients with PAM with atypia in one of their eyes who were treated by topical chemotherapy with MMC were included in this case study. Eyes with histologically proven PAM with atypia were treated by two to five courses of 0.04% (0.4 mg/ml) MMC four times a day. Each course lasted 2 continuous weeks. Follow-up was conducted on patients for control of local disease, side effects, and visual acuity in the treated eye. RESULTS: In all patients, there was complete or partial response to treatment. In four patients, the pigmentation disappeared, whereas in eight patients, some remnants of the pigmentation remained. In seven of these eight patients, the remnants of the pigmentation were stable during the follow-up period of 4 months to 9 years, whereas one in whom re-growth of the PAM was noticed was successfully treated again by topical MMC. No patients lost visual acuity at the end of the follow-up. All side effects of the local chemotherapy were resolved after cessation of the treatment. CONCLUSIONS: Topical MMC chemotherapy is a good alternative to surgical excision and cryotherapy in treating conjunctival PAM with atypia.     

Primary acquired melanosis with atypia treated with mitomycin C

The authors report the case of a 56-year-old Caucasian man who was found to have prominent melanotic conjuntival pigmentation inferotemporally in his right eye. Histopathologic evaluation disclosed malignant melanoma of the conjunctiva arising within primary acquired melanosis (PAM) associated with melanocytic atypia. The patient was treated by incisional conjunctival biopsy followed by two cycles of mitomycin C 0.04% eye drops and supplemental double-freeze thaw cryotherapy to residual foci of PAM. By 1 year following this treatment, there was no clinically apparent residual conjunctival melanosis, and visual acuity remained stable at 20/30. IRB approval has been waived for this case report.     

Conjunctival melanoma arising from diffuse primary acquired melanosis in a young black woman

PURPOSE: To report a case of conjunctival melanoma arising from diffuse primary acquired melanosis (PAM) with atypia in a young black woman in the context of previously published cases of this lesion in blacks. METHODS: Retrospective case report with literature review. The number and percentage of conjunctival melanomas occurring in black patients were determined from case series in which race was specified, published from 1950 to the present. RESULTS: Nodular multifocal conjunctival melanoma in a 30-year-old black woman was treated using surgical excision and adjuvant cryotherapy. Extensive PAM with severe atypia, including areas of microinvasive melanoma, was treated using topical mitomycin C. Literature review revealed 35 cases of conjunctival melanoma occurring in black patients. No previous reports of mitomycin C use in black patients with melanoma or PAM were identified. CONCLUSIONS: Conjunctival melanoma is an exceedingly rare tumor in black patients. The current case brings the total of reported cases to 36. We successfully treated nodular melanoma and diffuse PAM in a young black woman using a combination of excision with cryotherapy and topical mitomycin C, suggesting that these lesions are amenable to the same types of therapy previously described for white patients.     

Cryotherapy and laser treatment for acute retinopathy of prematurity: refractive outcomes, a longitudinal study

BACKGROUND—Infants who require treatment for threshold retinopathy of prematurity are at increased risk of developing refractive errors. Following the introduction of laser treatment for threshold disease, the clinical impression was that the degree of myopia was reduced compared with cryotherapy.
METHODS—A longitudinal study was carried out of refractive error at 3 and 12 months in 19 patients undergoing cryotherapy and 15 patients undergoing laser treatment.
RESULTS—At 3 months the median spherical equivalent refractive error in the right eye was −3.25 dioptres after cryotherapy and +0.25 dioptres after laser therapy (similar results left eye). The median spherical equivalent refractive error in the right eye at 12 months was -5.25 dioptres following cryotherapy and -0.50 dioptres after laser (similar results left eye). There was a statistically significant difference in median spherical refractive error between the therapies at 3 months and 12 months (p<0.05 Wilcoxon rank sum) in both eyes.
CONCLUSION—Laser therapy is associated with lower degrees of myopia during the first year of life, which is clinically significant in terms of visual performance and development.

     

Cytologic changes in the conjunctiva mimicking malignancy after topical mitomycin C chemotherapy

PurposeTo describe the epithelial changes observed in the conjunctiva secondary to the use of topical mitomycin C (MMC) for treatment of primary acquired melanosis with atypia.DesignRetrospective comparative case series.Participants and controlsConjunctival biopsy specimens (18) were taken during the follow-up of ten patients treated with MMC drops (0.02% or 0.04%) during 14 or 21 days for primary acquired melanosis with atypia. An equal number of age- and sex-matched patients with normal conjunctival biopsy findings were included for control. Conjunctival biopsy specimens from patients treated with MMC were compared with the morphologic changes already described in the urothelium following the use of the same chemotherapeutic agent.MethodsHematoxylin and eosin-stained biopsy samples were evaluated for recurrent neoplasm and chemotherapeutic effect in the epithelium using the following criteria: nuclear enlargement, nuclear hyperchromasia, smudging of the chromatin, presence of nucleoli, cytoplasmic eosinophilia, and individual cell necrosis.Main outcome measuresThe presence or absence of morphologic changes in the conjunctival epithelium related to the use of MMC.ResultsMorphologic features consistent with chemotherapy effect were seen in the biopsy specimens of nine patients. Nuclear enlargement and chromatin smudging-hyperchromasia localized in the superficial layers of the epithelium were the main features observed (9 patients). Cytoplasmic eosinophilia, single cell necrosis, and occasionally subepithelial chronic inflammation were also seen.ConclusionsSecondary changes with the topical use of MMC are seen in the conjunctival epithelium and are similar to the changes described in the urothelium. These changes are important to recognize and to differentiate from recurrent neoplasm. The localization of the described features in the superficial layers of the conjunctival epithelium is the key feature in the differential diagnosis.     

Longer term visual outcome of eyes with retinopathy of prematurity treated with cryotherapy or diode laser

AIMS—Visual outcome of 66 eyes in 37 patients who had undergone treatment with either cryotherapy or diode laser for threshold retinopathy of prematurity was assessed.
METHODS—17 patients, representing 30 eyes treated with cryotherapy, were examined at between 56 and 98 months corrected age (median 68 months). 20 patients representing 36 eyes treated with diode laser, were examined at between 30 and 66 months corrected age (median 51 months). Structural outcome was categorised as: optimal—flat posterior pole; suboptimal—macular ectopia, optic nerve hypoplasia, retinal fold involving the macula, and retinal detachment involving the macula.
RESULTS—Optimal structural outcome was, in the absence of amblyopia, associated with optimal visual acuity (of 6/12 or better) in all cases, with most eyes achieving a visual acuity of 6/9 or 6/6. Suboptimal structural outcome was invariably associated with suboptimal visual acuity. Amblyopia was present in eight out of 20 cryotherapy treated eyes and in five out of 26 laser treated eyes with an optimal structural outcome. Refractive errors were significantly less in laser treated eyes as was the incidence of anisometropic amblyopia.
CONCLUSION—Eyes treated with either cryotherapy or diode laser for threshold retinopathy of prematurity with optimal structural outcome are associated with development of optimal visual acuity—that is, 6/12 or better. Treatment with either cryotherapy or laser does not in itself reduce the visual potential of these eyes.

Keywords: retinopathy of prematurity; cryotherapy; laser; visual acuity     

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases

AIM—To evaluate the clinical features, treatment results, and recurrence rates in patients with either intraepithelial or invasive squamous cell carcinoma of the conjunctiva.
METHODS—Retrospective analysis of 60 cases (22 conjunctival intraepithelial and 38 invasive squamous cell carcinomas) to determine patterns of clinical presentation, aetiological factors, and treatment results. The mean patient age was 64 years old. 70% of the patients were male. Patients were treated with a variety of therapies, depending on the degree of tumour involvement; most cases were treated with frozen section controlled excision and adjunctive cryotherapy. Modified eye wall resection or enucleation was done for intraocular invasion and exenteration was done for orbital involvement.
RESULTS—Red eye (68%) and ocular irritation (57%) were the most common presenting symptoms. 44% of the patients had other eye findings consistent with extensive solar exposure. 20% of the patients had a history of malignant skin tumours. Visceral malignancies developed in 8%. Scleral involvement was present in 14 (37%), intraocular involvement in five (13%), and orbital invasion in four (11%) cases with invasive squamous cell carcinoma. After a mean follow up of 56 months (18-226 months) the rate of new or recurrent tumours was 4.5% for intraepithelial squamous carcinoma and 5.3% for invasive squamous cell carcinoma. No patient developed metastases or tumour related deaths.
CONCLUSION—Excision with intraoperative control of the surgical margins and adjunctive cryotherapy results in good tumour control rates.

Keywords: squamous cell carcinoma; conjunctiva     

Meta-analysis on the recurrence rates after bare sclera resection with and without mitomycin C use and conjunctival autograft placement in surgery for primary pterygium

BACKGROUND/AIMS—Bare sclera resection with and without use of mitomycin C and conjunctival autograft placement are three surgical techniques currently in use for the treatment of primary pterygium. The purpose of this study was to determine through a meta-analysis the risk for postoperative pterygium recurrence comparing the three surgical treatment modalities.
METHODS—A search through Medline for randomised controlled clinical trials comparing at least two of the three surgical techniques in the treatment of primary pterygium, along with a hand search of all references in relevant papers, was conducted. All eligible clinical trials were graded for quality utilising the Detsky score; those studies with a score of 0.5 or greater were included. The main outcome measurements were the pooled odds ratios and 95% confidence intervals for the risk of pterygium recurrence. These were calculated utilising the Mantel-Haenszel method.
RESULTS—Five eligible studies with an adequate quality score were retrieved, three comparing bare sclera resection with and without mitomycin C use, one comparing bare sclera resection with conjunctival autograft placement, and one comparing both. The pooled odds ratio for pterygium recurrence in patients who had only bare sclera resection was 6.1 (95% confidence intervals, 1.8 to 18.8) compared with the patients who had conjunctival autograft placement and 25.4 (9.0 to 66.7) compared with the patients who received mitomycin C.
CONCLUSIONS—The odds for pterygium recurrence following surgical treatment of primary pterygium are close to six and 25 times higher if no conjunctival autograft placement is performed or if no intra/postoperative mitomycin C is used, respectively. Surgeons and clinical triallists should not be encouraged in the use of bare sclera resection as a surgical technique for primary pterygium.

Keywords: meta-analysis; bare sclera resection; pterygium; mitomycin C     

Role of topical chemotherapy for primary acquired melanosis and malignant melanoma of the conjunctiva and cornea: review of the evidence and recommendations for treatment

Surgical excision with cryotherapy is a well-established treatment option for malignant melanoma or primary acquired melanosis (PAM) with atypia of the conjunctiva and cornea. Topical chemotherapeutic agents such as mitomycin C (MMC) however, are increasingly finding use in clinical practice. A search was performed of Medline and Pubmed databases for English language articles from 1980 to the present in this field. Relevant studies were reviewed with regards to treatment regimen, rates of recurrence and metastasis, side effect profile and length of follow up. A total of 22 and 16 unique cases of biopsy proven PAM with atypia and malignant melanoma, respectively, treated with topical MMC were identified. Topical MMC was well tolerated and shows considerable promise, particularly in the treatment of diffuse PAM with atypia. However, long-term data are lacking and further studies are required.     

Topical interferon alfa in the treatment of conjunctival melanoma and primary acquired melanosis complex

PURPOSE: To report on topical interferon alfa-2b for conjunctival malignant melanoma (CMM) and primary acquired melanosis with atypia (PAM). DESIGN: Retrospective, interventional case series. METHODS: Five eyes of five consecutive patients with biopsy-proven malignant melanoma were treated with topical interferon alfa-2b as treatment for primary or recurrent disease. One drop of interferon alfa-2b (1 million units/ml) was placed into the superior fornix four times daily for three months. Punctal plugs limited systemic absorption. The main outcome measure was tumor regression by clinical examination and comparative slit-lamp photography. RESULTS: Five consecutive patients with conjunctival melanoma (American Joint Committee on Cancer-International Union Against Cancer stages T2 [n = 3] and T3 [n = 2]) were included. Two patients had recurrent corneal tumors, eight and 13 months after local excision, cryotherapy, and topical mitomycin C therapy. Two months after topical interferon alfa-2b treatment, the lesions regressed without side effects. Two additional patients (who could not tolerate topical mitomycin C) were switched to topical interferon alfa-2b. They experienced transient chemical conjunctivitis and have no signs of recurrence (mean, 15 months of follow-up). The fifth had recurrent tumor despite multiple surgeries. This melanoma did not respond to topical interferon alfa-2b nor did the patient tolerate treatment (keratoconjunctivitis). No systemic side effects were noted. CONCLUSIONS: We present evidence that conjunctival and corneal melanoma regresses after exposure to topical interferon alfa-2b. A larger-scale longer-term study must evaluate the long-term efficacy and safety of this therapy.     

Role of chemotherapy alone or in combination with hyperthermia in the primary treatment of intraocular retinoblastoma: preliminary results

BACKGROUND—The efficacy of the etoposide-carboplatin combination in extraocular retinoblastoma is well known. This drug combination is therefore used in intraocular retinoblastoma, as primary reduction chemotherapy, before local treatment. The use of carboplatin in combination with diode laser hyperthermia as local treatment (thermochemotherapy) has been recently described as a conservative approach avoiding external beam radiotherapy in posterior pole tumours.
METHODS—All patients were reviewed, who were treated for retinoblastoma at the Institut Curie between June 1994 and October 1995, in whom treatment included either reduction chemotherapy or thermochemotherapy or both modalities successively. 23 patients presenting with unilateral (three) or bilateral (20) intraocular retinoblastoma received neoadjuvant chemotherapy consisting of two courses of etoposide 150 mg/m²/day and carboplatin 200 mg/m²/day for 3 days. 15 patients (17 eyes), eight of whom had already received neoadjuvant chemotherapy, were treated by thermochemotherapy.
RESULTS—Neoadjuvant chemotherapy: overall, seven eyes in seven patients could be treated conservatively, avoiding external beam irradiation, with a median follow up of 14 months. Thermochemotherapy: external beam irradiation was avoided for 14 of the 17 eyes treated.
CONCLUSION—Integration of neoadjuvant chemotherapy and combined treatment with carboplatin and diode laser, into the therapeutic armamentarium for retinoblastoma allows use of more aggressive treatments such as enucleation and external beam radiation.

Keywords: retinoblastoma; chemotherapy; thermochemotherapy     

Use of indomethacin for pain relief following scleral buckling surgery

BACKGROUND/AIMS—Patients undergoing scleral buckling and cryotherapy suffer from mild to moderate postoperative pain. As good pain relief facilitates postoperative ocular examination, as well as patient comfort and recovery, the authors designed a prospective randomised double masked trial to evaluate the efficacy of indomethacin as a satisfactory analgesic for such patients.
METHOD—Patients with a primary uncomplicated rhegmatogenous retinal detachment requiring scleral buckling and cryotherapy were randomly allocated to receive either indomethacin or placebo. A rectal suppository was administered 2 hours before surgery, followed by two capsules twice daily for 10 days. Pain relief was assessed with a linear graphic rating scale at the end of each day. Supplementary analgesia was allowed and recorded.
RESULTS—12 patients received indomethacin (group A) and 16 received placebo (group B). The extent of surgery was similar in both groups. One patient in group A, and two in group B withdrew after 3 days. The pain scores were converted to changes from the baseline (score on day 1), and the area under the curve calculated for each patient. The means of the areas were analysed with the Mann-Whitney test and showed that indomethacin caused a statistically significant reduction in pain score, both at 3 days (p=0.04) and at 10 days (p=0.014). There was no statistically significant difference in extra analgesic requirements between the two groups (p=0.2).
CONCLUSIONS—Indomethacin is recommended for short to medium term pain relief following scleral buckling and cryotherapy.

Keywords: retinal detachment; pain, explant; cryotherapy; indomethacin     

Topical anaesthesia with oxybuprocaine versus sub-Tenon's infiltration with 2% lignocaine for small incision cataract surgery

AIMS—To determine whether topical anaesthesia in small incision self-sealing phacoemulsification cataract surgery provides comparable anaesthesia to sub-Tenon's infiltration.
METHODS—Thirty five patients undergoing small incision self-sealing phacoemulsification cataract surgery were allocated randomly to receive topical anaesthesia with 0.4% oxybuprocaine or sub-Tenon's infiltration with 2% lignocaine. Pain experienced during the operation was assessed by asking the patient to score on a visual analogue graphic pain score chart.
RESULTS—The median pain score for the topical group (3) was significantly higher than that of the sub-Tenon's group (0) (p = 0.004).
CONCLUSION—Sub-Tenon's infiltration is superior to topical anaesthesia in ensuring patient comfort during small incision scleral tunnel self-sealing phacoemulsification cataract surgery.

     

Internal resection of posterior uveal melanomas

AIMS—To evaluate the safety and efficacy of internal resection in the treatment of malignant melanoma of the choroid.
METHODS—32 consecutive patients with histopathologically proved malignant choroidal melanomas were treated with internal resection. 29 of the 32 (90.6%) tumours were within 2 disc diameters of the optic nerve or fovea. The surgery was performed at two university centres by one of the authors. Follow up was between 1 and 85 months (mean 40.1 months).
RESULTS—Three patients developed distant metastases and died of malignant melanoma (metastatic and mortality rate 9.4%). In one case, distant metastases developed in association with an intraocular recurrence. There have been no other intraocular recurrences. The most common postoperative complication was vitreous haemorrhage, which occurred in 12 patients (37.5%); cataract occurred in eight eyes; and three patients developed retinal detachment postoperatively. Three of the operated eyes have been enucleated (9.4%); a total of four (12.5%) have lost light perception. 10 patients (31.2%) had visual acuities of 6/60 or better and 18 of 32 (56.3%) were between 6/120 and light perception.
CONCLUSION—These data suggest that the internal resection of posterior uveal melanomas is a reasonable globe saving management option. This treatment modality is particularly well suited to elevated tumours in close proximity to the optic nerve or fovea.

Keywords: choroidal melanoma; internal resection; malignant melanoma; posterior uveal melanoma