Uveal melanoma (UM) management is based on tumor, characteristics, prognostic factors, local availability of, treatment modalities, and patient preference.1 A detailed, discussion between the physician and the patient helps, navigate the complex shared decision-making process, (see Chapter 7). Herein, we discuss UM treatment, options (Mind map 28-1).
Chapter Keyword: choroidal melanoma
Lasers in Ophthalmic Oncology
Gerhard Meyer-Schwickerath, MD, was intrigued by the chorioretinal lesions, similar to diathermy scars, found in patients who had stared at a solar eclipse. In 1946, this observation prompted his first experiments with a car-bon-arc lamp from an old episcope. However, it wasn’t until 1949 that Meyer-Schwickerath used carbon arc photocoagulation as an alternative to enucleation for posterior choroidal melanomas.1,2 Then, in 1952, Vogel reported their results using xenon arc photocoagulation for 61 intraocular tumors.3-5
This chapter concentrates on newer ophthalmic lasers used in ophthalmic oncology. For example, Foulds used lower-energy, long-exposure combinations of argon green and then krypton red.6 Then, a wide-spot infrared laser (TTT) was introduced by Oosterhuis, popularized by Shields, and then largely abandoned.7 Most recently, PDT involves systemic intravenous administration of a photosensitizing dye (hematoporphyrin), which is then activated by a nonthermal laser.8
Thus, ophthalmic lasers and their applications have evolved into an accepted therapeutic option for select benign and malignant intraocular tumors.1-8 This chapter describes the attributes, applications, tissue interactions, current practice indications, and complications of ophthalmic laser photocoagulation for intraocular tumors.