Authors: Marieta Dumitrache, Rodica Lascu, Manea M, Miruna Cioboata.
The most common primary intraocular tumor of adults with clinical manifestations between 40-70 years of age is malignant choroidal melanoma (MCM), which represents 85% of uveal tumors, and which is frequently accompanied by serous retinal detachment. Symptomatically, MCM presents decreased vision (37%) depending on the extent, size, and location of the tumor, photopsia, visual field changes, but it can also be asymptomatic. Eye fundus examination reveals a prominent subretinal brown tumor with orange pigment on the surface, with a double vascular, tumoral and choroidal network. MCM can be complicated with retinal detachment (RD), cataract, secondary glaucoma, uveitis, vitreous hemorrhage. The reserved prognostic factors are: the presence of numerous epithelioid cells, vascular loops at the level of the tumor, associated with age greater than 65 years. In the evolution of MCM, depending on the size and extension of the tumor, the orbit may be invaded or there may be metastases in the liver, lungs, CNS, or recurrence after enucleation. MCM treatment is surgical, enucleation being indicated depending on the clinical stage, location, and tumor extension. The conservative treatment of MCM is radiotherapy (brachytherapy, with radioisotopes, I125, palladium 106, ruthenium 103, iridium 192, external radiotherapy in larger tumors and located below 4mm of the papilla and fovea, proton radiotherapy, transpupillary thermotherapy), and argon laser photocoagulation with limited indication and questionable efficiency (5% of patients benefit). Enucleation is indicated in large tumors, in eyes with low / lost vision, in invasive, extensive tumors, the surgical alternative being resection of the tumor with precise indications. Exenteration is indicated in extraocular extension of the tumor or in recurrence. Cytotoxic chemotherapy with alkylating agents (cispatalin, sunitinib) and immunotherapy. Any MCM must be diagnosed early, carefully monitored and the appropriate treatment of the tumor and metastases carried out, even having a vital prognosis.
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