IMPORTANT OPHTHALMIC
TUMOURS
MICHAEL E GIBLIN FRANZCOASIA PACIFIC SOCIETY OF OCULAR
ONCOLOGY AND PATHOLOGY
Uveal melanoma
Iris melanoma
• Large• Diffuse• Rapid growth• Hyphaema• Refractory glaucoma• Subjacent ciliary body
involvement
• Symptoms• Thickness > 2mm• Orange pigment (lipofuscin)• Growth• Subretinal fluid• Peripapillary location
Choroidal naevus versus melanoma
MM treatment options
• Observation• Transpupillary laser thermotherapy (TTT)
Posterior poleThickness < 3.5mm
Melanoma treatment options
• Observation• TTT• Local resection
Base < 10mmAnterior to equator
MM treatment options
• Observation• TTT• Local resection• Radioactive plaque therapy
Base <15(18)mmThickness < 8mm
Ruthenium 106
Iodine 125
MM treatment options
• Observation• TTT• Local resection• Radioactive plaque therapy• Proton beam/helium ion irradiation• Stereotactic R/T; LINAC/gamma knife
MM treatment options
• Observation• TTT• Local resection• Radioactive plaque therapy• Proton beam/helium ion irradiation• Sterertactic radiotherapy• Enucleation
Base > 18mm
BAP1
• BAP1 = BRCA Associated Protein 1
• Recessive cancer suppression gene
• Located on 3p21.1• Associated with monosomy 3• Inactivating mutation leads to liver metastasis
Circumscribed choroidal haemangioma
High internal reflectivity
Metastatic tumours
•May be multifocal•Characteristically posterior to equator•Usually amelanotic•Leopard-skin RPE spotting•Sub-retinal fluid if active•Treat if sight affected•Lung ca. Choroidal metastasis may precede detection of primary
Retinoblastoma
•Aim for earlier detection•Chemotherapy mainstay of treatment for hereditary retinoblastoma
• Incresing role for intraarterial chemotherapy
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