Roelofs, KA; Fabian, ID; Arora, AK; Cohen, VML; Sagoo, MS; (2021) Long-term Outcomes of Small Pigmented Choroidal Melanoma Treated with Primary Photodynamic Therapy. Ophthalmology Retina , 5 (5) pp. 468-478. 10.1016/j.oret.2020.08.019.

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Abstract

PURPOSE: To report the long-term outcomes of patients with small, pigmented posteriorly located choroidal melanoma undergoing primary treatment using photodynamic therapy (PDT) with verteporfin at the London Ocular Oncology Service. DESIGN: Retrospective interventional consecutive case series SUBJECTS: All patients undergoing primary treatment using PDT with verteporfin from April 2014 and December 2015 and followed until December 2019. METHODS: This is a long-term follow up study of the same cohort of patients previously reported by our group in 2017 and 2018. MAIN OUTCOME MEASURE: Local tumor control, visual outcomes and metastasis-free survival. RESULTS: Twenty-six patients were included with a mean (± SD) age and tumour thickness of 62 ± 14 years and 1.3 ± 0.5 mm, respectively. Tumours were posteriorly located (mean distance to optic nerve and fovea = 2.0 ± 2.2 and 1.6 ± 1.5 mm, respectively) and the majority were fully pigmented (73%). Overall, patients were followed for a median [IQR, range] of 49.5 [15.3, 7.0 - 66.0] months from first PDT to last follow up. Over the course of this study, 14/26 (54%) have developed a local recurrence at a median of 20.0 months [20.5, 4.7 - 60.9 months]. The most common pattern of recurrence was an isolated increase in basal dimensions (9/14; 64%). Median [IQR] final LogMAR visual acuity of the whole cohort was 0.2 [0.5]. The only statistically significant difference in baseline and outcome characteristics between treatment failures and non-failures was distance to fovea (median [IQR]: 0.5 [1.3] versus 2.5 [2.8]; P = 0.002) and final LogMAR visual acuity (median [IQR]: 0.50 [0.80] versus 0.00 [0.14]; P-value = 0.002), respectively. CONCLUSIONS: While treatment of small pigmented posterior choroidal melanoma with PDT effectively preserves visual acuity, five-year treatment-success calculated by Kaplan-Meier analysis was only 38.4%. Recurrences after PDT tend to occur along the tumor edges, often with minimal increase in thickness. Given the substantial risk of treatment failure, primary PDT with vertepofrin is recommended in exceptional cases of choroidal melanoma, where other treatments with greater tumor control are not a feasible option.

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