Photodynamic therapy as initial treatment for small choroidal melanomas

PurposeTo evaluate Verteporfin photodynamic therapy (PDT) as primary treatment for small, posterior choroidal melanoma.DesignRetrospective cohort review.Subjects, participants and controlsRetrospective case note review of 20 patients with small juxtapapillary and juxtafoveal choroidal melanomas treated with PDT at the Liverpool Ocular Oncology Clinic.MethodsPatient and tumour characteristics, PDT session details, visual acuity and B-scan ultrasonography measurements as well as colour fundus photographs at each examination were collated and analysed.Main outcome measuresLocal tumour control and Best Corrected Visual Acuity (BCVA).ResultsThe 20 patients (14 male, 6 female) had a mean age of 61.2 years (range, 40–85) and were treated between 2001 and 2012. Seven tumours were amelanotic, while 13 were pigmented. Of 20 melanomas, 11 (55%) showed complete regression on B-scan ultrasonography and colour photography; five (25%) showed partial regression; four (20%) remained unchanged and two (10%) showed further growth, for which alternative standard treatment was required. Baseline BCVA was 0.1 logMAR (mean; range 0.0–0.6) compared to a post-PDT BCVA of 0.4 logMAR (mean; range −0.2 to 1.7) over a follow-up of 60.0 months (mean; range 25–156 months).ConclusionsPDT can induce tumour regression in a significant proportion of small, posterior, choroidal melanomas but is less reliable than other forms of therapy. It may have a role in patients with special visual requirements if they accept the increased risk of treatment failure requiring radiotherapy.