The Infrared Diode Laser (810 nm) for Transpupillary Thermotherapy in Human Malignant Choroidal Melanomas
Purpose: To demonstrate efficacy of transpupillary thermotherapy (TTT) with an infrared diode laser (810 nm) as primary and non adjuvant treatment modality for choroidal melanoma.
Case report and method: Performance of TTT and postoperative findings are evaluated in case of a patient, who developed a malignant choroidal melanoma in the temporal midperiphery of his better right eye. Vision of his left eye was very poor because of strabismic amblyopia. Tumor thickness was 2.3 mm. TTT was performed using a diode laser (810 nm) with a beam diameter of 2.0 mm, power setting of 0.3 watt and exposure time of 1 minute. During permanently slit lamp observation the energy level was raised stepwise until edema turned the tumor tissue grey-whitish. Follow-up examinations took place in four-week-intervals. Clinical aspect, ultrasonographic tumor thickness, fluorescein angiography, visual acuity and side effects were recorded during 21 months follow-up. During 4 months after TTT the tumor regressed completely to a flat chorioretinal scar. No tumor thickness remained ultrasonographically and no residual tumor vessels were detected by fluorescein angiography. Visual acuity was 0.5. During almost two years follow-up no ocular side effects, no tumor recurrence or metastases were observed.
Discussion: Transpupillary thermotherapy is a new treatment modality for choroidal melanoma, which is generally used complementary to brachytherapy. Our case report demonstrates efficacy and safety of TTT as single and non adjuvant therapy of a small choroidal melanoma in the midperiphery of an oculus ultimus functionalis. Larger studies and longer follow-up are necessary for data regarding tumor recurrence and metastases.