Download PDF
Klin Monbl Augenheilkd 2017; 234(07): 874-885
DOI: 10.1055/s-0043-114421
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Chirurgische Methoden in der Behandlung des Aderhautmelanoms

Surgical Methods in the Treatment of Uveal Melanoma
Georgios Blatsios
Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
,
Gertrud Haas
Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
,
Claus Zehetner
Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
,
Nikolaos E. Bechrakis
Universitätsklinik für Augenheilkunde und Optometrie, Medizinische Universität Innsbruck, Innsbruck, Österreich
› Author Affiliations
Further Information

Publication History

eingereicht 04 April 2017

akzeptiert 20 June 2017

Publication Date:
25 July 2017 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

In der Behandlung von Aderhautmelanomen wurden in den letzten Jahrzehnten signifikante Fortschritte erzielt. Die lokale Tumorkontrolle kann mit Strahlentherapie je nach Methodik in bis zu 98% der Fälle erreicht werden. Chirurgische Techniken werden zur Behandlung von Strahlenkomplikationen, wie dem sogenannten toxischen Tumorsyndrom, oder zur primären Therapie des Tumors in Kombination mit oder ohne Strahlentherapie angewendet. Hierzu werden endo- und transsklerale Resektionstechniken für Melanome der Aderhaut und des Ziliarkörpers oder Iridotrabekulozyklektomie für Melanome der Iris und des Ziliarkörpers verwendet. Darüber hinaus spielt die Tumorbiopsie eine zunehmend wichtigere Rolle bei der Diagnose, Behandlung und Nachbehandlung von choroidalen Melanomen. Diese Übersichtsarbeit erläutert die therapeutischen Indikationen und chirurgischen Techniken sowie die Ergebnisse und Komplikationen im Rahmen der Exzision und Biopsie von Aderhautmelanomen.

Abstract

Significant advancements have been made in the last decades in the treatment of uveal melanoma. Radiation therapy can achieve, depending on the method, local tumour control in up to 98% of cases. Surgical modalities have been implemented in the ocular therapy for uveal melanoma either to treat/prevent radiation complications, such as so-called toxic tumour syndrome, or to primarily treat the tumour with or without adjunctive radiotherapy. These include endoresection and transscleral resection for melanomas of the choroid/ciliary body or irido-trabeculo-cyclectomy for melanomas of the iris-ciliary body. Furthermore, tumour biopsy is playing a progressively more important role in the diagnosis, treatment and follow-up planning of melanoma cases. This paper focuses on the background, the surgical technique as well as the results and complications of tumour excisional and biopsy surgery.

Schlüsselwörter

transsklerale Resektion - Iridotrabekulozyklektomie - Biopsie - Endoresektion - Melanom

Key words

melanoma - endoresection - transscleral resection - biopsy - irido-trabeculo-cyclectomy
 

  • Literatur

  • 1 Damato B. Progress in the management of patients with uveal melanoma. The 2012 Ashton Lecture. Eye (Lond) 2012; 26: 1157-1172
    CrossrefPubMedGoogle Scholar
  • 2 Damato B, Lecuona K. Conservation of eyes with choroidal melanoma by a multimodality approach to treatment: an audit of 1632 patients. Ophthalmology 2004; 111: 977-983
    CrossrefPubMedGoogle Scholar
  • 3 Damato BE. Treatment selection for uveal melanoma. Dev Ophthalmol 2012; 49: 16-26
    PubMedGoogle Scholar
  • 4 Damato BE, Foulds WS. Ciliary body tumours and their management. Trans Ophthalmol Soc U K 1986; 105 (Pt 2): 257-264
    PubMedGoogle Scholar
  • 5 Bechrakis NE, Bornfeld N, Zoller I. et al. [Iodine-125 brachytherapy and trans-scleral tumor resection in large uveal melanomas]. Ophthalmologe 2001; 98: 736-742
    CrossrefPubMedGoogle Scholar
  • 6 Bechrakis NE, Bornfeld N, Zoller I. et al. Iodine 125 plaque brachytherapy versus transscleral tumor resection in the treatment of large uveal melanomas. Ophthalmology 2002; 109: 1855-1861
    CrossrefPubMedGoogle Scholar
  • 7 Bechrakis NE, Foerster MH. Neoadjuvant proton beam radiotherapy combined with subsequent endoresection of choroidal melanomas. Int Ophthalmol Clin 2006; 46: 95-107
    CrossrefPubMedGoogle Scholar
  • 8 Giuliari GP, Sadaka A, Hinkle DM. et al. Current treatments for radiation retinopathy. Acta Oncologica 2011; 50: 6-13
    CrossrefPubMedGoogle Scholar
  • 9 Bianciotto C, Shields CL, Pirondini C. et al. Proliferative radiation retinopathy after plaque radiotherapy for uveal melanoma. Ophthalmology 2010; 117: 1005-1012
    CrossrefPubMedGoogle Scholar
  • 10 Tschentscher F, Husing J, Holter T. et al. Tumor classification based on gene expression profiling shows that uveal melanomas with and without monosomy 3 represent two distinct entities. Cancer Res 2003; 63: 2578-2584
    PubMedGoogle Scholar
  • 11 Rodrigues MJ, Stern MH. Genetic landscape of uveal melanoma. J Fr Ophtalmol 2015; 38: 522-525
    CrossrefPubMedGoogle Scholar
  • 12 Ewens KG, Kanetsky PA, Richards-Yutz J. et al. Chromosome 3 status combined with BAP1 and EIF1AX mutation profiles are associated with metastasis in uveal melanoma. Invest Ophthalmol Vis Sci 2014; 55: 5160-5167
    CrossrefPubMedGoogle Scholar
  • 13 Muller HK. [Partial excision of the iris and ciliary body]. Doc Ophthalmol 1969; 26: 679-697
    CrossrefPubMedGoogle Scholar
  • 14 Muller HK, Lund OE, Seidel G. [Ten yearsʼ experience with cyclectomy]. Bibl Ophthalmol 1968; 75: 89-100
    PubMedGoogle Scholar
  • 15 Muller HK, Lund OE, Sollner F. et al. [The operative treatment of tumors of the chamber angle and ciliary body]. Doc Ophthalmol 1966; 20: 500-518
    PubMedGoogle Scholar
  • 16 Stallard HB. Surgery of malignant melanoma of the iris. Br J Ophthalmol 1951; 35: 774-783
    CrossrefPubMedGoogle Scholar
  • 17 Stallard HB. Partial Cyclectomy. Br J Ophthalmol 1961; 45: 797-802
    CrossrefPubMedGoogle Scholar
  • 18 Stallard HB. Partial iridocyclectomy and sclerectomy. Br J Ophthalmol 1966; 50: 656-659
    CrossrefPubMedGoogle Scholar
  • 19 Stallard HB. Partial choroidectomy. Br J Ophthalmol 1966; 50: 660-662
    CrossrefPubMedGoogle Scholar
  • 20 Willerding GD, Cordini D, Moser L. et al. Neoadjuvant proton beam irradiation followed by transscleral resection of uveal melanoma in 106 cases. Br J Ophthalmol 2016; 100: 463-467
    CrossrefPubMedGoogle Scholar
  • 21 Damato B, Foulds WS. Indications for trans-scleral local resection of uveal melanoma. Br J Ophthalmol 1996; 80: 1029-1030
    CrossrefPubMedGoogle Scholar
  • 22 Foulds WS. The local excision of choroidal melanomata. Trans Ophthalmol Soc U K 1973; 93: 343-346
    PubMedGoogle Scholar
  • 23 Foulds WS. Experience of local excision of uveal melanomas. Trans Ophthalmol Soc U K 1977; 97: 412-415
    PubMedGoogle Scholar
  • 24 Foulds WS. Current options in the management of choroidal melanoma. Trans Ophthalmol Soc U K 1983; 103 (Pt 1): 28-34
    PubMedGoogle Scholar
  • 25 Foulds WS. Do we need a retinal pigment epithelium (or choroid) for the maintenance of retinal apposition?. Br J Ophthalmol 1985; 69: 237-239
    CrossrefPubMedGoogle Scholar
  • 26 Foulds WS. Management of intraocular melanoma. Br J Ophthalmol 1990; 74: 559-560
    CrossrefPubMedGoogle Scholar
  • 27 Foulds WS. The uses and limitations of intraocular biopsy. Eye (Lond) 1992; 6 (Pt 1): 11-27
    CrossrefPubMedGoogle Scholar
  • 28 Foulds WS. Local resection and other conservative therapies for intraocular melanoma. Curr Opin Ophthalmol 1995; 6: 62-69
    CrossrefPubMedGoogle Scholar
  • 29 Foulds WS, Damato BE. Alternatives to enucleation in the management of choroidal melanoma. Aust N Z J Ophthalmol 1986; 14: 19-27
    CrossrefPubMedGoogle Scholar
  • 30 Foulds WS, Damato BE, Burton RL. Local resection versus enucleation in the management of choroidal melanoma. Eye (Lond) 1987; 1 (Pt 6): 676-679
    CrossrefPubMedGoogle Scholar
  • 31 Foulds WS, Lee WR, Roxburgh ST. et al. Can chorio-retinal biopsy be justified?. Trans Ophthalmol Soc U K 1985; 104 (Pt 8): 864-868
    PubMedGoogle Scholar
  • 32 Bechrakis NE, Petousis V, Willerding G. et al. Ten-year results of transscleral resection of large uveal melanomas: local tumour control and metastatic rate. Br J Ophthalmol 2010; 94: 460-466
    CrossrefPubMedGoogle Scholar
  • 33 Damato BE, Paul J, Foulds WS. Predictive factors of visual outcome after local resection of choroidal melanoma. Br J Ophthalmol 1993; 77: 616-623
    CrossrefPubMedGoogle Scholar
  • 34 Damato BE, Paul J, Foulds WS. Risk factors for metastatic uveal melanoma after trans-scleral local resection. Br J Ophthalmol 1996; 80: 109-116
    CrossrefPubMedGoogle Scholar
  • 35 Damato BE, Paul J, Foulds WS. Risk factors for residual and recurrent uveal melanoma after trans-scleral local resection. Br J Ophthalmol 1996; 80: 102-108
    CrossrefPubMedGoogle Scholar
  • 36 Shields CL, Say EAT, Hasanreisoglu M. et al. Personalized prognosis of uveal melanoma based on cytogenetic profile in 1059 patients over an 8-year period: The 2017 Harry S. Gradle lecture. Ophthalmology 2017; DOI: 10.1016/j.ophtha.2017.04.003.
    CrossrefPubMedGoogle Scholar
  • 37 Staby KM, Gravdal K, Mork SJ. et al. Prognostic impact of chromosomal aberrations and GNAQ, GNA11 and BAP1 mutations in uveal melanoma. Acta Ophthalmol 2017; DOI: 10.1111/aos.13452.
    CrossrefPubMedGoogle Scholar
  • 38 Barnhill RL, Ye M, Batistella A. et al. The biological and prognostic significance of angiotropism in uveal melanoma. Lab Invest 2017; DOI: 10.1038/labinvest.2017.16.
    CrossrefPubMedGoogle Scholar
  • 39 Puusaari I, Damato B, Kivela T. Transscleral local resection versus iodine brachytherapy for uveal melanomas that are large because of tumour height. Graefes Arch Clin Exp Ophthalmol 2007; 245: 522-533
    CrossrefPubMedGoogle Scholar
  • 40 Kivela T, Puusaari I, Damato B. Transscleral resection versus iodine brachytherapy for choroidal malignant melanomas 6 millimeters or more in thickness: a matched case-control study. Ophthalmology 2003; 110: 2235-2244
    CrossrefPubMedGoogle Scholar
  • 41 Garcia-Arumi J, Montolio Gil M, Morral Palau M. et al. Sympathetic ophthalmia after surgical resection of iridociliary melanoma. A case report. Graefes Arch Clin Exp Ophthalmol 2006; 244: 1353-1356
    CrossrefPubMedGoogle Scholar
  • 42 Kertes PJ, Johnson JC, Peyman GA. Internal resection of posterior uveal melanomas. Br J Ophthalmol 1998; 82: 1147-1153
    CrossrefPubMedGoogle Scholar
  • 43 Peyman GA, Charles H. Internal eye wall resection in the management of uveal melanoma. Can J Ophthalmol 1988; 23: 218-223
    PubMedGoogle Scholar
  • 44 Peyman GA, Cohen SB. Ab interno resection of uveal melanoma. Int Ophthalmol 1986; 9: 29-36
    PubMedGoogle Scholar
  • 45 Peyman GA, Koziol J. Limitation of eye wall resection. Can J Ophthalmol 1974; 9: 328-337
    PubMedGoogle Scholar
  • 46 Peyman GA, May DR, Ericson ES. et al. Full-thickness eye wall resection: an experimental approach for treatment of choroidal melanoma. II. Homo- and heterograft. Invest Ophthalmol 1972; 11: 668-674
    PubMedGoogle Scholar
  • 47 Peyman GA, Nelsen PT, Axelrod AJ. et al. Full-thickness eye wall resection: evaluation of preoperative photocoagulation. Invest Ophthalmol 1973; 12: 262-266
    PubMedGoogle Scholar
  • 48 Peyman GA, Raichand M. Full-thickness eye wall resection of choroidal neoplasms. Ophthalmology 1979; 86: 1024-1036
    CrossrefPubMedGoogle Scholar
  • 49 Peyman GA, Sanders DR, May DR. Full-thickness eye wall resection: technique, case descriptions, and histological findings. Trans Ophthalmol Soc N Z 1977; 29: 123-129
    PubMedGoogle Scholar
  • 50 Biewald E, Lautner H, Gok M. et al. Endoresection of large uveal melanomas: clinical results in a consecutive series of 200 cases. Br J Ophthalmol 2017; 101: 204-208
    CrossrefPubMedGoogle Scholar
  • 51 Damato B. Choroidal melanoma endoresection, dandelions and allegory-based medicine. Br J Ophthalmol 2008; 92: 1013-1014
    CrossrefPubMedGoogle Scholar
  • 52 Damato B, Groenewald C, McGalliard J. et al. Endoresection of choroidal melanoma. Br J Ophthalmol 1998; 82: 213-218
    CrossrefPubMedGoogle Scholar
  • 53 Damato B, Wong D, Green FD. et al. Intrascleral recurrence of uveal melanoma after transretinal “endoresection”. Br J Ophthalmol 2001; 85: 114-115
    PubMedGoogle Scholar
  • 54 Garcia-Arumi J, Distefano LN, Quijano C. Endoresection of a high equatorial choroidal melanoma. Retin Cases Brief Rep 2015; 9: 30-32
    CrossrefPubMedGoogle Scholar
  • 55 Garcia-Arumi J, Leila M, Zapata MA. et al. Endoresection technique with/without brachytherapy for management of high posterior choroidal melanoma: extended follow-up results. Retina 2015; 35: 628-637
    CrossrefPubMedGoogle Scholar
  • 56 Garcia-Arumi J, Sararols L, Martinez V. et al. Vitreoretinal surgery and endoresection in high posterior choroidal melanomas. Retina 2001; 21: 445-452
    CrossrefPubMedGoogle Scholar
  • 57 Garcia-Arumi J, Zapata MA, Balaguer O. et al. Endoresection in high posterior choroidal melanomas: long-term outcome. Br J Ophthalmol 2008; 92: 1040-1045
    CrossrefPubMedGoogle Scholar
  • 58 Gunduz K, Bechrakis NE. Exoresection and endoresection for uveal melanoma. Middle East Afr J Ophthalmol 2010; 17: 210-216
    CrossrefPubMedGoogle Scholar
  • 59 Hadden PW, Damato BE, McKay IC. Bilateral uveal melanoma: a series of four cases. Eye (Lond) 2003; 17: 613-616
    CrossrefPubMedGoogle Scholar
  • 60 Hadden PW, Hiscott PS, Damato BE. Histopathology of eyes enucleated after endoresection of choroidal melanoma. Ophthalmology 2004; 111: 154-160
    CrossrefPubMedGoogle Scholar
  • 61 Susskind D, Durr C, Paulsen F. et al. Endoresection with adjuvant ruthenium brachytherapy for selected uveal melanoma patients – the Tuebingen experience. Acta Ophthalmol 2016; DOI: 10.1111/aos.13306.
    CrossrefPubMedGoogle Scholar
  • 62 Schilling H, Bornfeld N, Talies S. et al. [Endoresection of large uveal melanomas after pretreatment by single-dose stereotactic convergence irradiation with the leksell gamma knife–first experience on 46 cases]. Klin Monatsbl Augenheilkd 2006; 223: 513-520
    Article in Thieme ConnectPubMedGoogle Scholar
  • 63 Cassoux N, Cayette S, Plancher C. et al. Choroidal melanoma: does endoresection prevent neovascular glaucoma in patient treated with proton beam irradiation?. Retina 2013; 33: 1441-1447
    CrossrefPubMedGoogle Scholar
  • 64 Konstantinidis L, Groenewald C, Coupland SE. et al. Long-term outcome of primary endoresection of choroidal melanoma. Br J Ophthalmol 2014; 98: 82-85
    CrossrefPubMedGoogle Scholar
  • 65 Damato B, Groenewald CP, McGalliard JN. et al. Rhegmatogenous retinal detachment after transscleral local resection of choroidal melanoma. Ophthalmology 2002; 109: 2137-2143
    CrossrefPubMedGoogle Scholar
  • 66 Callejo SA, Dopierala J, Coupland SE. et al. Sudden growth of a choroidal melanoma and multiplex ligation-dependent probe amplification findings suggesting late transformation to monosomy 3 type. Arch Ophthalmol 2011; 129: 958-960
    CrossrefPubMedGoogle Scholar
  • 67 Lake SL, Coupland SE, Taktak AF. et al. Whole-genome microarray detects deletions and loss of heterozygosity of chromosome 3 occurring exclusively in metastasizing uveal melanoma. Invest Ophthalmol Vis Sci 2010; 51: 4884-4891
    CrossrefPubMedGoogle Scholar
  • 68 Coupland SE, Kalirai H, Ho V. et al. Concordant chromosome 3 results in paired choroidal melanoma biopsies and subsequent tumour resection specimens. Br J Ophthalmol 2015; 99: 1444-1450
    CrossrefPubMedGoogle Scholar
  • 69 Dyson C. Iridocyclectomy with lamellar scleral resection. Can J Ophthalmol 1972; 7: 297-301
    PubMedGoogle Scholar
  • 70 Peyman GA, Raichand M, Schulman J. Diagnosis and therapeutic surgery of the uvea – part I: Surgical technique. Ophthalmic Surg 1986; 17: 822-829
    PubMedGoogle Scholar
  • 71 Rospond-Kubiak I, Damato B. The surgical approach to the management of anterior uveal melanomas. Eye (Lond) 2014; 28: 741-747
    CrossrefPubMedGoogle Scholar
  • 72 Daubner D, Prokosch V, Busse H. et al. [Long-term results of iridocyclectomy for iris tumours]. Klin Monatsbl Augenheilkd 2008; 225: 1045-1050
    Article in Thieme ConnectPubMedGoogle Scholar
  • 73 OʼKeeffe M, Nabil M. The use of mannitol in intraocular surgery. Ophthalmic Surg 1983; 14: 55-56
    PubMedGoogle Scholar
  • 74 Petousis V, Finger PT, Milman T. Anterior segment tumor biopsy using an aspiration cutter technique: clinical experience. Am J Ophthalmol 2011; 152: 771-775
    CrossrefPubMedGoogle Scholar
  • 75 Bechrakis NE, Foerster MH, Bornfeld N. Biopsy in indeterminate intraocular tumors. Ophthalmology 2002; 109: 235-242
    CrossrefPubMedGoogle Scholar
  • 76 Finger PT, Milman T. Microincision, aspiration cutter-assisted multifocal iris biopsy for melanoma. Eur J Ophthalmol 2017; 27: 62-66
    CrossrefPubMedGoogle Scholar
  • 77 Correa ZM, Augsburger JJ. Independent prognostic significance of gene expression profile class and largest basal diameter of posterior uveal melanomas. Am J Ophthalmol 2016; 162: 20-27 e21
    CrossrefPubMedGoogle Scholar
  • 78 Pelayes DE, Zarate JO. Fine needle aspiration biopsy with liquid-based cytology and adjunct immunohistochemistry in intraocular melanocytic tumors. Eur J Ophthalmol 2010; 20: 1059-1065
    CrossrefPubMedGoogle Scholar
  • 79 Singh AD, Biscotti CV. Fine needle aspiration biopsy of ophthalmic tumors. Saudi J Ophthalmol 2012; 26: 117-123
    CrossrefPubMedGoogle Scholar
  • 80 Trichopoulos N, Augsburger JJ. Neuroendocrine tumours metastatic to the uvea: diagnosis by fine needle aspiration biopsy. Graefes Arch Clin Exp Ophthalmol 2006; 244: 524-528
    CrossrefPubMedGoogle Scholar
  • 81 Midena E, Parrozzani R. Biopsies in uveal melanoma. Dev Ophthalmol 2012; 49: 81-95
    PubMedGoogle Scholar
  • 82 Shields JA, Shields CL, Ehya H. et al. Fine-needle aspiration biopsy of suspected intraocular tumors. The 1992 Urwick Lecture. Ophthalmology 1993; 100: 1677-1684
    CrossrefPubMedGoogle Scholar
  • 83 Biewald E, Metz KA, Bornfeld N. [Value of transretinal tumor biopsy as diagnostic and predictive instrument]. Ophthalmologe 2013; 110: 882-884
    CrossrefPubMedGoogle Scholar
  • 84 Grixti A, Angi M, Damato BE. et al. Vitreoretinal surgery for complications of choroidal tumor biopsy. Ophthalmology 2014; 121: 2482-2488
    CrossrefPubMedGoogle Scholar
  • 85 Akgul H, Otterbach F, Bornfeld N. et al. Intraocular biopsy using special forceps: a new instrument and refined surgical technique. Br J Ophthalmol 2011; 95: 79-82
    CrossrefPubMedGoogle Scholar
  • 86 Augsburger JJ, Shields JA, Folberg R. et al. Fine needle aspiration biopsy in the diagnosis of intraocular cancer. Cytologic-histologic correlations. Ophthalmology 1985; 92: 39-49
    CrossrefPubMedGoogle Scholar
  • 87 Folberg R, Augsburger JJ, Gamel JW. et al. Fine-needle aspirates of uveal melanomas and prognosis. Am J Ophthalmol 1985; 100: 654-657
    CrossrefPubMedGoogle Scholar
  • 88 Margo CE. Episcleral pseudomelanoma: late complication of scleral tunnel incision. Am J Ophthalmol 2003; 135: 387-389
    CrossrefPubMedGoogle Scholar
  • 89 Seregard S, All-Ericsson C, Hjelmqvist L. et al. Diagnostic incisional biopsies in clinically indeterminate choroidal tumours. Eye (Lond) 2013; 27: 115-118
    CrossrefPubMedGoogle Scholar
  • 90 Singh AD, Medina CA, Singh N. et al. Fine-needle aspiration biopsy of uveal melanoma: outcomes and complications. Br J Ophthalmol 2016; 100: 456-462
    CrossrefPubMedGoogle Scholar
  • 91 Mashayekhi A, Lim RP, Shields CL. et al. Extraocular extension of ciliochoroidal melanoma after transscleral fine-needle aspiration biopsy. Retin Cases Brief Rep 2016; 10: 289-292
    CrossrefPubMedGoogle Scholar
  • 92 Desjardins L, Lumbroso-Le Rouic L, Levy-Gabriel C. et al. Treatment of uveal melanoma by accelerated proton beam. Dev Ophthalmol 2012; 49: 41-57
    PubMedGoogle Scholar
  • 93 Bechrakis NE, Foerster MH. Where is the superiority of proton radiation for ocular tumours?. Graefes Arch Clin Exp Ophthalmol 2002; 240: 513-514
    CrossrefPubMedGoogle Scholar
  • 94 Metz CH, Lohmann D, Zeschnigk M. et al. [Uveal melanoma: current insights into clinical relevance of genetic testing]. Klin Monatsbl Augenheilkd 2013; 230: 686-691
    Article in Thieme ConnectPubMedGoogle Scholar