脉络膜黑色素瘤敷贴放射治疗的初步观察

目的 观察脉络膜黑色素瘤敷贴放射治疗的效果。 方法 采用国产敷贴器对间接检眼镜、荧光素眼底血管造影、吲哚青绿血管造影、B型超声等综合检查确诊的脉络膜黑色素瘤患者21例21只眼进行治疗。棕色实性隆起的圆形或椭圆形肿物位于黄斑周围者7只眼、视盘周围者7只眼、血管弓及附近者5只眼、周边部者2只眼。B型超声检查显示瘤体最大径为13.0 mm×11.6 mm×9.6 mm。视力0.05及其以下者3只眼，0.06至0.2者4只眼，0.3及其以上者14只眼。敷贴器所用核素为 125 I，设定照射总量为100~120 Gy。其中肿瘤位于黄斑、视盘周围的14只眼同时合并采用经瞳孔温热疗法治疗。治疗后观察时间平均12个月，最长者达3年。以B型超声测量瘤体的基底及厚(高)度，若厚度超过原厚度的15%，或基底边缘大于原边缘250 mm视为肿物增大。 结果 治疗后视力下降9只眼，不变10只眼，提高2只眼。瘤体增大6只眼，不变12只眼，缩小3只眼。并发玻璃体积血2只眼，视网膜血管阻塞1只眼，视网膜分支静脉阻塞1只眼，黄斑皱褶1只眼，视网膜出血3只眼，部分性视神经萎缩3只眼，新生血管性青光眼1只眼，眼球摘出3只眼。 结论 用国产敷贴器对脉络膜黑色素瘤进行放射治疗具有确切的疗效。但对瘤体较厚、肿瘤位于黄斑或视盘旁者效果较差。 (中华眼底病杂志, 2006, 22: 157-160)     

脉络膜黑色素瘤的治疗

脉络膜黑色素瘤的治疗方法有多种,如定期观察、敷贴放疗、带电粒子照射、局部切除、经瞳孔温热疗法(transpupillarythermotherapy ,TTT)、眼球摘除、眶内容剜除、化疗和免疫疗法等。现在的发展趋势已由光凝疗法转到对小肿瘤应用TTT ,或对中等、较大肿瘤应用TTT联合放射治疗。本文就脉络膜黑色素瘤患者的治疗方法作一概述。     

脉络膜黑色素瘤的治疗

脉络膜黑色素瘤的治疗方法有多种，如定期观察、敷贴放疗、带电粒子照射、局部切除、经瞳孔温热疗法(transpupillary thermotherapy，TTT)、眼球除、眶内容剜除、化疗和免疫疗法等。现在的发展趋势已由光凝疗法转到对小肿瘤应用TTT，或对中等、较大肿瘤应用TTT联合放射治疗。本就脉络膜黑色素瘤患的治疗方法作一概述。     

经瞳孔温热疗法联合敷贴放疗治疗脉络膜黑色素瘤的临床观察

目的观察经瞳孔温热疗法联合敷贴放疗治疗脉络膜黑色素瘤治疗的效果。方法采用半导体激光治疗仪联合国产敷贴器对脉络膜黑色素瘤患者17例17只眼进行治疗并对效果进行观察。结果治疗后视力下降6只眼,不变8只眼,提高3只眼。瘤体增大7只眼,不变7只眼,缩小3只眼。治疗后平均观察时间12个月,最长者达3年。黄斑皱褶1只眼,视网膜出血2只眼,部分性视神经萎缩1只眼,眼球摘出5只眼。结论经瞳孔温热疗法联合敷贴放疗治疗脉络膜黑色素瘤具有确切疗效。但对瘤体较厚者效果较差。     

敷贴放射联合经瞳孔温热疗法治疗脉络膜黑色素瘤的初步观察

　　目的　观察巩膜表面敷贴放射（PRT）联合经瞳孔温热疗法（TTT）治疗脉络膜黑色素瘤（CM）的治疗效果。方法　采用国产巩膜敷贴器联合TTT对30例CM患者的30只眼进行治疗。其中,男性15例,女性15例;均为单眼。视力0.1～0.8,平均视力0.3±0.2。肿瘤最大基底径6.80～17.90 mm,平均最大基底径（11.30±2.80） mm;高度3.90～10.60 mm,平均高度（7.20±2.40）mm。肿瘤局部控制标准：对比B型超声测量下的肿瘤大小,若肿瘤高度增加2.00 mm或肿瘤任意一边界扩展0.25 mm视为肿瘤生长。治疗后随访15～57个月,平均随访时间（33.01±9.81）个月,观察肿瘤局部控制率、眼球保存率、治疗后视力以及治疗后并发症的发生情况。结果　治疗后肿瘤最大基底径4.60～17.00 mm,平均最大基底径为（9.79±3.35）mm。与治疗前肿瘤平均最基底径比较,差异有统计学意义（t=2.195,F=0.49;P=0.032）;肿瘤高度为2.70～11.90 mm,平均高度（5.19±2.57） mm。与治疗前肿瘤平均高度比较,差异有统计学意义（t=2.069,F=0.018;P=0.043）。末次随访时,肿瘤最大基底径较治疗前最大基底径增加2只眼;肿瘤高度较治疗前肿瘤高度增加2只眼。肿瘤局部控制率为86.7%。治疗后眼球摘除3只眼,眼球保存率为90.0%。视力保持稳定12只眼,占40.0%;视力提高1只眼,占3.3%;视力下降17只眼,占56.7%。出现放射性视网膜病变12只眼,占40.0%;继发性视网膜脱离3只眼,占10.0%,其中伴有继发性青光眼1只眼;白内障4只眼,占13.3%;干眼症症状5只眼,占16.7%。结论　PRT联合TTT能有效控制肿瘤生长,并发症发生率低。      

X刀治疗脉络膜黑色素瘤的疗效评估

目的　观察X刀立体定向放射治疗对脉络膜黑色素瘤的疗效及贯穿眼睑直肌牵拉眼球固定法的效果。方法　采用Vrian 2 10 0C直线加速器 ,6× 10 6VX刀对 16例 (16只眼 )瘤体为 11 8mm× 10 0mm× 4 5mm的脉络膜黑色素瘤患者进行立体定向放射治疗 (平均边缘剂量为 2 3 4Gy) ,观察其临床疗效 ,并对其进行评估。放疗前先将眼球固定 ,即局部浸润性麻醉 (不用球后注射 ) ,于 4条直肌附着处置牵引缝线 ,上下穹窿中部贯穿眼睑 ,分别固定于眉上、眶下缘、鼻根、眶外缘处深及骨膜。平均随访 18 5个月 (12～ 36个月 )。结果　瘤体于治疗后 6～ 12个月内明显缩小 7例 (43 8% ) ;1～ 2年时 ,11例 (6 8 8% )肿瘤缩小。其中 4例肿瘤处残留小盘状痕迹 ,3例肿瘤缩小不明显 ,3例肿瘤因有轻微增大而行眼球摘除术。瘤体局部控制率为 81 3%。除视网膜及其膜下可见小片状出血外 ,余无其他严重并发症。眼球固定良好 ,放疗定位准确。结论　脉络膜黑色素瘤的X刀立体定向放射治疗法效果较好 ,无严重并发症 ,瘤体局部控制率高。贯穿眼睑直肌牵拉固定眼球法效果可靠     

脉络膜黑色素瘤多中心随机对照研究22年回顾

脉络膜黑色素瘤是成年人最常见的眼内原发性恶性肿瘤,对于眼球摘除及其他一系列保留眼球的治疗方法的效果始终存在争议.1986年"眼黑色素瘤合作研究(COMS)"在美国和加拿大43家临床中心开展,两大著名的试验研究包括眼球摘除前放射治疗和单纯眼球摘除治疗大脉络膜黑色素瘤的对照试验,以及125I敷贴放射治疗和眼球摘除术治疗中等体积脉络膜黑色素瘤的对照研究.这两项研究规模宏大,研究内容丰富,二十多年来所得出的成果对脉络膜黑色素瘤的诊治有重要的指导意义.     

国产125I巩膜敷贴器治疗兔眼脉络膜黑色素瘤的有效性及安全性研究

背景 脉络膜黑色素瘤(CM)是成人眼内常见的原发性恶性肿瘤,巩膜表面敷贴放射治疗(EPRT)是一种近距离放射疗法,是多年来治疗CM最常用的方法之一.但该治疗方法的研究与应用目前在国内报道较少,大多数的CM患者需行眼球摘除术. 目的 通过观察兔CM模型眼、正常兔眼经敷贴放射后的反应以及兔全身免疫状态,评价国产125I巩膜敷贴器的有效性及安全性.方法 新西兰大白兔40只,按随机数字表法分成5个组,每组8只兔8只眼(均取右眼).其中放射治疗组1及模型对照组用于评价国产125I巩膜敷贴器的有效性;放射治疗组2、伪放射对照组、正常对照组用于评价国产125I巩膜敷贴器的生物安全性.有效性研究:利用B16F10鼠皮肤黑色素瘤细胞株植入兔眼制作动物模型,造模3周后放射治疗组1模型兔眼放置国产125I巩膜敷贴器进行放射治疗,肿瘤局部照射总剂量为100 Gy,模型对照组不进行治疗.每日间接检眼镜检查,每周行眼底照相、B型超声、彩色超声多普勒检查.安全性研究:放射治疗组2正常兔眼放置巩膜敷贴器,伪放射对照组正常兔眼植入不带放射粒子的敷贴器外壳,正常对照组不作任何干预.放射治疗组2、伪放射对照组于放置敷贴器前及敷贴器取出后3、7、15、30 d抽取外周血,用流式细胞术检测外周血CD4+、CD8+T细胞数量.于放射治疗组1、模型对照组肿瘤种植后6周,放射治疗组2、伪放射对照组、正常对照组观察30 d后耳缘静脉空气栓塞法处死实验兔,对实验眼进行常规组织病理学检查. 结果 放射治疗组1、模型对照组间放置敷贴器前肿瘤的平均高度差异无统计学意义(P=0.550).放置敷贴器1周后,放射治疗组1肿瘤高度明显小于模型对照组,差异有统计学意义(P=0.001);放射治疗组1放置敷贴器2周后肿瘤高度较敷贴前明显缩小,差异有统计学意义(P=0.007).常规组织病理学检查发现,与模型对照组比较,放射治疗组1虽然仍有肿瘤细胞残存,但肿瘤内部血管明显减少且管径较细,肿瘤细胞排列紊乱,部分细胞空泡样变性,色素外露,大量纤维结缔组织增生.安全性研究中,放射治疗组2、伪放射对照组在各时间点CD4+、CD8+、CD4+/CD8+T细胞流式细胞术结果比较,差异均无统计学意义(F分组=0.770、8.110、2.230;P=0.380、0.060、0.140;F时间 =0.770、3.220、4.230;P=0.550、0.170、0.004).放射治疗组2、伪放射对照组表现为角膜、结膜上皮下、巩膜表面慢性炎性细胞浸润,未见巩膜坏死、机化等表现. 结论 国产125I巩膜敷贴器对兔眼CM的疗效确切,对眼部其他组织以及兔全身免疫状态的影响较小.     

脉络膜黑色素瘤敷贴放射治疗后黄斑区形态变化的光相干断层扫描检查

目的 观察脉络膜黑色素瘤敷贴放射治疗(PRT)后黄斑区形态变化.方法 对临床确诊的48例脉络膜黑色素瘤患者的48只眼行125I PRT.患者肿瘤均未累及黄斑区.视力0.02～1.0,平均视力0.4±0.2.治疗前均行光相干断层扫描(OCT)检查,采用放射状6线扫描模式获取黄斑区形态图像.黄斑区形态表现为视网膜脱离者18只眼,占37.5％;视网膜色素上皮(RPE)改变12只眼,占25.0％;水肿、前膜以及脱离伴水肿、渗出和RPE改变者7只眼,占14.6％;黄斑区视网膜形态基本正常11只眼,占22.9％.治疗后随访1～24个月,平均随访时间(10.4±5.9)个月.随访观察患眼肿瘤控制以及视力变化情况,并以治疗前相同的设备和方法进行黄斑区形态的OCT检查.对比观察治疗前与治疗后末次随访黄斑区形态的变化;分析黄斑形态变化与PRT以及视力变化的关系和影响因素.结果 48例患者经PRT后肿瘤控制良好.视力提高2例,占4.2％;视力不变10例,占20.8％;视力下降36例,占75.0％.治疗前后视力差异有统计学意义(Z=-3.778,P＜0.05).末次随访OCT检查,黄斑区形态表现为视网膜脱离者13只眼,占27.1％;RPE改变9只眼,占18.8％;水肿,脱离伴水肿、渗出和RPE改变者17只眼,占35.4％;增生、萎缩、脱离伴出血渗出和水肿前膜者6只眼,占12.5％;黄斑视网膜形态基本正常3只眼,占6.3％.15例患者呈现两种及两种以上的黄斑区形态异常变化,占31.3％.结论 PRT后脉络膜黑色素瘤患者黄斑区形态异常主要表现为视网膜脱离、RPE改变、黄斑水肿、渗出.黄斑区结构异常的比例增加,31.3％的患者呈现两种及两种以上的黄斑区形态异常.     

葡萄膜黑色素瘤经巩膜表面敷贴放射治疗的预后及其影响因素

巩膜表面敷贴放射治疗是治疗葡萄膜黑色素瘤的一种近距离放射疗法,肿瘤局部控制率、转移率以及患者生存率与其他疗法相比并无差异,但能保留眼球并维持部分视力,对正常组织及全身损伤较小,安全且疗效可靠.治疗预后受肿瘤大小、位置、退行速度、生长方式、敷贴剂量率、放射性核素的种类、敷贴器放置的精准度、敷贴器的形状以及患者年龄等多种因素影响.     

Treatment options for choroidal malignant melanoma: a case report featuring transpupillary thermotherapy.

BACKGROUND: Choroidal melanoma is the most common primary ocular tumor in adults. These tumors are almost always unilateral and develop spontaneously or arise from pre-existing nevi. Historically, treatment for choroidal melanoma was enucleation. New therapies have been developed to treat choroidal melanoma and to preserve the eye. Currently, these treatment options include brachytherapy and transpupillary thermotherapy. CASE REPORT: A 51-year-old man came to the eye clinic with symptoms of mildly decreased fluctuating vision and floaters with no flashes in the temporal visual field of the right eye. Best-corrected visual acuities were 20/30 O.D. and 20/20 O.S. A small-to-medium choroidal lesion was found in the right eye. Ultrasonography and A-scan showed this lesion to be a choroidal malignant melanoma. The patient's surgical options included enucleation, brachytherapy, and transpupillary thermotherapy. The patient opted to have transpupillary thermotherapy to preserve the eye, and subsequently underwent two procedures that eventually obliterated the melanoma, resulting in best-corrected visual acuity of 20/40. CONCLUSION: Transpupillary thermotherapy is an excellent option for treatment of small-to-medium choroidal melanomas. Brachytherapy is also an option for treatment, but with increased ocular side effects and complications. Enucleation is still commonly performed on medium and/or large choroidal melanomas.     

经瞳孔温热疗法治疗三种眼底良性肿瘤

目的 观察经瞳孔温热疗法（TTT）治疗三种眼内良性肿瘤的疗效。 方法 通过最佳矫正视力、眼压、视野、眼前节和眼底检查以及彩色眼底照相、荧光素钠和吲哚青绿血管造影、B型超声、光相干断层扫描（OCT）、CT等检查确诊的眼内良性肿瘤患者17例20只眼。男12例，女5例，右眼8只，左眼12只。其中，视盘血管瘤3例3只眼，平均视力为0.17，2只眼曾行手术放液;脉络膜血管瘤9例9只眼，平均视力为0.39，其中4例为首诊病例，5只眼曾做过激光光凝治疗，肿瘤未全平复，尚有浆液性视网膜脱离;脉络膜骨瘤5例8只眼，平均视力为0.20，其中3只眼合并黄斑出血。TTT用810 nm半导体红外激光，光斑3.0 mm，按肿物大小连接照射1～5个光斑。功率360～1200 mW，时间60～80 s。1～3次为1疗程，2次治疗之间间隔时间1个月;需要时再作1疗程治疗。治疗后定期随访观察，时间为3～36个月，平均随访时间14.5个月。 结果 随访结束时平均视力，视盘血管瘤患者为0.27，脉络膜血管瘤患者为0.46，脉络膜骨瘤患者为0.31。视盘血管瘤3只眼瘤体的红色部位缩小，表面纡曲扩张的血管变平直，视盘周围出现脉络膜萎缩弧，视网膜下浆液性渗出消失。脉络膜血管瘤9只眼瘤体透红光区消失，视网膜下积液消退，治疗区色素增生。脉络膜骨瘤8只眼中视网膜下积液吸收，肿瘤颜色由黄红变为黄白，并出现色素和薄的瘢痕，合并黄斑出血者出血消失。所有患眼治疗后未出现严重并发征。 结论 TTT治疗视盘血管瘤、脉络膜血管瘤和脉络膜骨瘤，无论首次接受治疗或补充以前治疗均获一定效果。 (中华眼底病杂志, 2006, 22:181-184)     

经瞳孔温热疗法治疗限局性脉络膜血管瘤

目的探讨经瞳孔温热疗法治疗限局性脉络膜血管瘤的临床效果。方法经眼底检查和荧光素眼底血管造影确诊为限局性脉络膜血管瘤的患者10例（10只眼）,年龄16—48岁,平均34岁。采用经瞳孔温热疗法,以810红外激光对病变区连续照射1～5个光斑,光斑直径3．0mm,将肿物完全覆盖。激光功率为800～1200mw,照射时间60s,或延长10～20s。术后1—3个月随诊。视病情需要可重复治疗1～3次。患者随访期3～36个月,平均14个月。其中4例患者为首次治疗;6例曾接受绿激光（氪和氩）光凝治疗。结果末诊时,有1例脉络膜血管瘤患者病变正位于黄斑中心区,视网膜下尚有积液,眼底有透红光区,需继续治疗,余9例视网膜下积液完全消退,荧光素眼底血管造影和吲哚氰绿脉络膜血管造影检查,肿瘤区无强荧光出现,视力增进;经过半年至2年随诊,患者病情稳定。未发生术后并发症或后遗症。结论经瞳孔温热疗法治疗限局性脉络膜血管瘤的临床效果肯定。无论单独作为首选治疗或用于补充以前光凝治疗的不足,均可获得良好效果。（中华眼科杂志,2005,41：882-886）     

玻璃体视网膜联合手术切除脉络膜黑色素瘤

目的 探讨玻璃体视网膜手术切除脉络膜黑色素瘤的疗效、安全性及其适应证范围。 方法 8例脉络膜黑色素瘤，直径5～20　mm,厚4～12　mm。4例合并视网膜脱离。2例经眼内肿瘤切除，6例行板层巩膜脉络 膜切除。8例均联合玻璃体视网膜手术，包括玻璃体切割，过氟化碳液体应用，眼内光凝，气体或硅油充填。 结果 术后病理检查证实：7例为脉胳膜黑色素瘤，其中5例为梭形细胞型，2例混合细胞型，3例累及 睫状体。1例为脉络膜黑色素细胞瘤。经2～24个月(平均9.1个月)随访，未发现肿瘤复发与转移，眼球外形均无明显改变，5例视力在0.1以上。 结论 对选择性病例采用玻 璃体视网膜手术切除脉络膜黑色素瘤可以保留患眼，挽救视力，而且对切除组织病理检查可 明确诊断。（中华眼底病杂志，2000，16：139-212）     

Treatment of choroidal melanoma using photodynamic therapy

PURPOSE: To InternetAdvance publication at ajo.com Feb 26, 2002. investigate the effect of photodynamic therapy using verteporfin on choroidal melanoma. DESIGN: Interventional case series. METHOD: Four patients with choroidal melanoma who showed recurrence or no response after previous brachytherapy and transpupillary thermotherapy were treated with photodynamic therapy. RESULTS: One tumor decreased in size and remained stable for 18 months. One tumor had no growth for 11 months. Two melanomas continued to grow, necessitating enucleation. CONCLUSIONS: Of the four eyes that had failed conventional therapies, two would have been salvaged (to date) with photodynamic therapy. However, additional studies are needed to determine if photodynamic therapy can play a role in the management of choroidal melanoma.     

Transpupillary thermotherapy in the management of circumscribed choroidal hemangioma

Laser photocoagulation and various radiation therapy methods have been used in the treatment of circumscribed choroidal hemangioma that produce visual loss. Recently, transpupillary thermotherapy has been employed in the management of choroidal hemangioma. Thirty-six cases of choroidal hemangioma treated with transpupillary thermotherapy are reviewed. Twenty-eight cases were reported in the literature and 10 cases were managed by the author. Transpupillary thermotherapy has been used as a primary treatment (36 cases) or secondary treatment (2 cases) for choroidal hemangioma. The goal of transpupillary thermotherapy is to achieve resolution of exudative detachment of the fovea and improvement of vision. In all eyes the foveal detachment subsided. In 26 eyes having pretreatment visual acuity >or=0.05 (20/400), the visual acuity increased in 20 (77%) eyes and remained unchanged in 6 (23%) eyes. After transpupillary thermotherapy, 16 (42%) cases showed complete regression, 20 (53%) demonstrated partial regression, and in 2 (5%) there was no change in tumor thickness at follow-ups ranging from 2 to 44 months. Complications of transpupillary thermotherapy of choroidal hemangioma included cystoid macular edema (3 eyes), preretinal fibrosis (2 eyes), focal iris atrophy (3 eyes), and retinal vascular occlusion (1 eye). Although the follow-up in many studies is limited, transpupillary thermotherapy has not been associated with any significant complications.     

Clinicopathologic findings in choroidal melanomas after failed transpupillary thermotherapy

PURPOSE: To review the clinicopathologic features of eyes enucleated after failed transpupillary thermotherapy. DESIGN: Retrospective review. METHODS: Pathology reports in the L.F. Montgomery Laboratory between 1998 and 2002 were searched for enucleated eyes with choroidal melanoma that had been treated only by transpupillary thermotherapy (TTT) prior to enucleation. The clinical features of the patients, including ultrasonography examination, were reviewed and compared with the pathologic findings. RESULTS: Seven eyes from seven patients had been enucleated, representing 8% of eyes treated with TTT at our institute during the period studied. The primary indication for enucleation was tumor growth. The melanomas tended to grow laterally, with minimal if any increase in thickness. Five of the seven eyes histologically demonstrated extrascleral extension, which was detected by ultrasonography prior to enucleation in only one of those eyes. CONCLUSIONS: Choroidal melanoma may continue to grow along a path of least resistance after TTT. The melanoma may extend laterally in the choroid and through emissary canals. Early extrascleral extension may be difficult to detect by ultrasonography.     

Transpupillary thermotherapy versus plaque radiotherapy for suspected choroidal melanomas

PURPOSE: To examine the outcomes and complications of transpupillary thermotherapy for treatment of small choroidal melanomas. DESIGN: Retrospective case-matched comparative study and retrospective observational study. PARTICIPANTS: The case-matched study consisted of 36 patients treated with either transpupillary thermotherapy or plaque radiotherapy (18 patients per group). The observational study consisted of 21 patients treated with transpupillary thermotherapy alone (primary transpupillary thermotherapy) and 9 patients treated with transpupillary thermotherapy plus plaque radiotherapy (adjuvant transpupillary thermotherapy). MAIN OUTCOME MEASURES: Visual acuity, local tumor control, and metastasis. RESULTS: The case-matched groups did not differ significantly with respect to age, gender, initial visual acuity, tumor location, or length of follow-up (mean, 33 months for transpupillary thermotherapy vs. 40 months for plaque radiotherapy). There was no significant difference in final visual acuity (P = 0.810) or postoperative visual acuity change (P = 0.919) between the 2 groups. In the observational study, the mean follow-up was 32 months (range, 4-58 months). Indications for primary transpupillary thermotherapy included documented growth (10 patients) and the presence of >/=3 risk factors for growth (11 patients). Retinal complications occurred in 16 patients (76%). The mean posttreatment visual acuity change was minus 2 lines (range, minus 9 to plus 7 lines). Local failure occurred in 6 patients (29%). Local failure was associated with an increased number of transpupillary thermotherapy spots per session (P = 0.023) and decreased tumor pigmentation (P = 0.001). Indications for adjuvant transpupillary thermotherapy included tumor radioresistance (6 patients) and the presence of risk factors for local failure (3 patients). All 9 tumors that received adjuvant transpupillary thermotherapy regressed rapidly, with no local failures. The mean postoperative visual acuity change was -1.9 lines (range, -9 to +5 lines). No patient in either study developed metastasis. CONCLUSIONS: The recent interest in transpupillary thermotherapy as primary therapy for choroidal melanoma is based largely on the assumption that transpupillary thermotherapy may provide better visual outcomes than plaque radiotherapy. However, this study found no significant difference in visual outcomes between transpupillary thermotherapy and plaque radiotherapy. Further, the local failure rate with transpupillary thermotherapy was substantially higher than with plaque radiotherapy. The most promising role for transpupillary thermotherapy seems to be as an adjunct to plaque radiotherapy. The appropriate indications for transpupillary thermotherapy in the management of choroidal melanoma need to be re-evaluated.