Retina-Vitreous
2017 , Vol 25 , Num 2
Endoresection and Transscleral Approaches in Intraocular Tumor Surgery
Prof. Dr., Ankara Üniversitesi Tıp Fakültesi Göz Hastalıkları Anabilim Dalı
Surgical excision in uveal tumors can be done via iridectomy, partial
lamellar sclerouvectomy (PLSU), and endoresection. PLSU
is employed in tumors involving the iridociliary, ciliary body, ciliochoroidal
and peripheral choroidal tumors. In PLSU surgery, a
partial thickness scleral fl ap is dissected, the intraocular tumor
is excised, and the fl ap is sutured back in position. PLSU surgery is done in iridociliary and ciliary body tumors with less than 3
clock hours of iris and ciliary body involvement and in choroidal
tumors with a base diameter less than 15 mm. However, it can be
employed in any size tumor for biopsy purposes. Endoresection is
a relatively new technique whereby the intraocular tumor is excised
using vitrectomy techniques. The rationale for performing
endoresection is based on the fact that irradiated uveal melanomas
may be associated with exudation, neovascular glaucoma,
intraocular pigment and tumor dissemination and removing the
dead tumor tissue may contribute to better visual outcome. There
are some centers where endoresection is done without prior radiotherapy.
Allegedly, avoidance of radiation retinopathy and papillopathy
are the main advantages of using endoresection without
prior radiotherapy. PLSU, endoresection with or without prior
external radiotherapy have similar vision, local recurrence, globe
preservation, and metastasis rates compared to radiotherapeutic
methods. PLSU and endoresection have become established as
important surgical techniques that can be considered in the management
of intraocular tumors.
Keywords :
Uveal tumor, ciliary body tumor, choroidal tumor, plaque radiotherapy, partial lamellar sclerouvectomy, endoresection, pars plana vitrectomy, radiotherapy