Abstract
PURPOSE: To investigate the surgical effect and safety of a novel technique for the excision of intraocular choroidal melanoma in order to reduce the risk of serious adverse events. METHODS: This retrospective study analyzed 23 patients with choroidal melanoma (23 eyes) from January 2016 to December 2022. Instead of the standard peripheral retina incision and subsequent tumor removal, we performed phacoemulsification and complete vitrectomy with tumor and overlying retina removal under high intraocular pressure. Without further retinal reattachment, the basal sclera is preserved. The tumor was resected, leaving 1-2 mm of the surrounding normal retina and choroid. The resection edge was further treated with laser therapy, which was followed by the replacement of heavy water with silicone oil. Finally, the vitreous cavity was filled with silicone oil. The median operation time was 1.5 h (1.2-2.5 h). Complete ophthalmic examinations were performed 1 day, 1 week, and 1, 3, and 6 months postoperatively. Systemic examination was conducted every 6 months. RESULTS: The median duration for all surgeries was 1.5 h (range: 1.2-2.5 h). Minor bleeding occurred at the mass resection margin intraoperatively, and the minimal-to-little hyphema observed on postoperative day 1 in all patients was absorbed 3-7 days later. No retinal detachment was noted at a mean follow-up of 42.5 ± 6.9 (range, 36-60) months. The best-corrected visual acuity at the last follow-up was lower than that before surgery (P = 0.001), One patient required enucleation due to intraocular recurrence, and one patient died from metastatic choroidal melanoma. The remaining patients remained healthy during the follow-up period. CONCLUSION: Maintaining a vitreous cavity filled with half air and half heavy water while excising the choroidal tumor and the overlying retina is a simple, effective, and safe surgical approach.