Surgical Treatment of a Large Choroidal Melanoma

Purpose: We report successful eyeball-preserving management of a patient with large choroidal melanoma. combined partial lamellar sclerouvectomy (PLSU) ruthenium (Ru)-106 plaque brachytherapy.Case summary: A 48-year-old woman history asthma visited our clinic chief complaint gradual loss vision at the nasal side her right eye (best-corrected visual acuity 0.6). Fundus examination revealed mushroom-shaped, dark mass 17.1 mm (basal diameter) × 14.2 (apical height). There was no evidence distant metastasis. To remove tumor while preserving eyeball, we PLSU and simultaneous Ru-106 brachytherapy under hypotensive general anesthesia. At 6 weeks postoperatively, trans pars plana vitrectomy silicone oil injection performed to vitreous hemorrhage treat retinal detachment. Intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) (0.05 mL, 1.25 mg) injected every 2 months prevent development radiation retinopathy. No residual tumor, recurrence, or metastasis noted during follow-up years. The stable ocular complications last visit (2 years postoperatively).Conclusions: Contrary what expected despite surgical difficulties, is useful strategy even when encountering very melanoma (diameter > 16 apical height 10 mm). Such previously believed be treatable only via enucleation.