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    Surgical Treatment of a Large Choroidal Melanoma

    AAO 2022 Video Program
    Ocular Pathology/Oncology, Retina/Vitreous, Tumors , Vitreoretinal Surgery

    This video demonstrates successful eyeball-preserving management of a large choroidal melanoma using partial lamellar sclerouvectomy (PLSU) with ruthenium 106 plaque brachytherapy. A 48-year-old woman with a past history of asthma visited the clinic with a chief complaint of gradual right-eye vision loss at the nasal side. A mushroom-shaped, dark-pigmented choroidal mass was noted on fundus exam. Tumor size was 17.12 mm (basal diameter) × 14.21 mm (apical height) on orbital magnetic resonance imaging, with no evidence suggesting distant metastasis. For tumor resection with preservation of the eyeball, PLSU was performed with simultaneous 106Ru plaque brachytherapy. Additional pars plana vitrectomy, cataract surgery, silicone oil injection, and intravitreal methotrexate injection were performed, with intravitreal bevacizumab injection every 2 months. The patient is in stable clinical condition with no sign of tumor recurrence or ocular complications at postoperative 1 year. PLSU with 106Ru plaque brachytherapy is a useful eyeball-preserving treatment strategy even for large choroidal melanomas with apical height exceeding 14 mm.

    Financial Disclosures: Drs. Min Kim, Seung Min Lee, and Hansang Lee disclose no financial relationships.