Retinal detachment after trans-scleral local resection of choroidal melanoma

Abstract

Rhegmatogenous retinal detachment is one of the main complications of trans-scleral local resection of choroidal melanoma. Purpose. To determine the incidence and outcome of rhegmatogenous retinal detachment after trans-scleral local resection for choroidal melanoma. Methods. 67 patients with choroidal melanoma treated consecutively by choroidectomy (50) or cyclochoroidectomy (17) between 1993 and 1995 by a single surgeon (B.D.) were analysed prospectively. Results. Mean patient age was 48.5 yrs, tumour diameter was 13.1mm; tumour thickness was 8.4mm. 36% of tumours extended less than two disc diameters from disc or fovea and 52% extended anterior to ora serrata. Nine patients developed retinal detachment by the close of the study, with Kaplan Meier estimation showing a 14% actuarial rate at 93 days. Although Cox multivariate analysis did not identify any risk factors, the clinical impression is that the resections were technically difficult, because of optic disc involvement (1), extraocular extension (1), longstanding total exudative retinal detachment (1) and pathological tumour diameter more than 16mm (4). Vitreo-retinal surgery achieved anatomical success in 6/9 cases and by the close of the study the eye was retained in 7/9 cases. Conclusion. With appropriate surgical expertise, rhegmatogenous retinal detachment is an uncommon complication after trans-scleral local resection of choroidal melanoma, and can usually be treated successfully.