Perspective from Carol L. Shields, MD
January 13, 2014
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Transpupillary thermotherapy effective in treating many choroidal melanomas

Perspective from Carol L. Shields, MD
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PHILADELPHIA — Transpupillary thermotherapy is still a viable treatment option for many types of choroidal melanoma, a speaker told colleagues here.

“Transpupillary thermotherapy has been a subject of some controversy recently, and I disagree with some of the things that have been said and written,” Jerry A. Shields, MD, said at Macula 2014.

He showed a case in which transpupillary thermotherapy (TTT) reduced a pigmented lesion within about 3 months.

“I can tell you that if we had used proton beam or plaque radiotherapy, we would not have had such a good result,” Shields said. “So, there’s still a role for it. … We found some long-term problems, but they can be managed.”

Plaque radiotherapy is a sound alternative for tumors involving the optic disc, Shields said.

“Plaque radiotherapy rather than enucleation is an acceptable method for most choroidal melanomas that touch, surround and obscure the disc. We’ve treated well over 1,000 cases,” he said.

Combined treatment has also been shown to be effective.

“Most of the time today, we combine plaque radiotherapy with TTT, so-called sandwich treatment, and you can see the result, before and after, with disappearance of the tumor and the retinal detachment,” Shields said.

Plaque radiotherapy may also be used for corneal melanoma, he said.

Small iris tumors of less than 3 clock hours may be removed with iridectomy or iridocyclectomy, Shields said.

"It’s much better if you can remove these tumors locally and leave everything else intact,” he said.

Disclosure: Shields has no relevant financial disclosures.