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The treatment for intraocular
melanoma depends on the size and location of the tumor, whether the
cancer has spread, and the person's overall health. The main reasons
for treating intraocular melanoma are to reduce the risk of the
tumor spreading and maintain the health and vision of the eye, if
possible. In many cases, a team of doctors may work with the patient
to determine the best treatment plan.
Observation
This approach may be used to manage small or slow-growing tumors, or
for people without any symptoms, older or seriously ill people, or
people with a tumor in their only useful eye. If the tumor grows
bigger than 10 mm in diameter or 2 mm to 3 mm in height (thickness),
then the doctor and the patient may decide to proceed with
treatment.
Surgery
Surgery to the eye is quite common in the treatment of intraocular
melanoma. During surgery, the ophthalmologist will remove parts of
the affected eye or even the entire eye, depending on the size and
spread of the tumor.
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Iridectomy: Removal of part of
the iris
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Iridocyclectomy: Removal of part
of the iris and ciliary body
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Sclerouvectomy/endoresection:
Surgery to remove the choroidal tumor and still keep the eye
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Enucleation: Removal of the eye
Surgery is also used to place the
radioactive plaque for internal radiation therapy (brachytherapy).
(More information about radiation therapy is below.)
The potential side effects of eye surgery are similar to that of any
surgery, including a risk of infection, problems from the anesthesia
(the medication that puts you "to sleep" during surgery), and pain.
With total removal of the eye, there is a slight risk that the tumor
could come back around the edges of the eye area.
Having an eye removed (enucleation)
Sometimes the only choice a doctor has in treating intraocular
melanoma is to remove the eye. This means that the person will lose
all of their vision in that eye. Because of this vision loss, a
person with one eye may have trouble with depth perception and may
not be able to see as well when looking straight ahead. Most people
adjust to these differences within a year after having the surgery.
Many people worry about what they will look like when they have an
eye removed. The cosmetic surgery available today usually yields
good cosmetic results. To fill the area left by the missing eye, the
person is fitted for an artifical plastic eye (prosthesis). The
prothesis will look and behave almost the same as a natural eye. For
example, the plastic eye will move along with the person's remaining
eye, just not as much as a natural eye moves. Family members may be
able to tell that the eye is not real, but it is unlikely that
strangers will know. It may take many weeks for patients to receive
the prosthesis.
Radiation therapy/radiotherapy
Radiation therapy uses radiation to kill or damage cancer cells.
There are different types of radiotherapy.
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Proton beam or charged particle
radiotherapy targets high-energy particles to the tumor. Unlike
x-rays, this type of radiation can be directed at the tumor, which
reduces the possibility of damage to nearby tissue.
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Brachytherapy is a procedure
where the ophthalmologist places a radioactive disc (sometimes
called a plaque) near the tumor. Sometimes this is called internal
radiation therapy or plaque therapy.
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Traditional external beam
radiation therapy delivers x-rays from outside the body to the
tumor and may be given after enucleation or as a palliative
treatment.
Radiation therapy can result in a
variety of side effects, so it is important to talk to your
ophthalmologist about what to expect. The extent of side effects
depends on the type and dose of radiation the patient receives,
where the tumor is located, and the patient's general health. The
side effects may not show up right away.
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Cataracts are very common. A
cataract is when the lens of the eye becomes cloudy. People with
cataracts may have cloudy or foggy vision, have trouble seeing at
night, or have problems with glare from the sun or bright lights.
If the cataract is causing major problems with a person's
eyesight, it can be surgically removed.
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Loss of eyelashes and/or a dry
eye can occur with external beam radiation.
These side effects are much less
common and can cause a loss of vision.
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Radiation retinopathy: The
development of abnormal blood vessels in the retina
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Radiation optic neuropathy:
Optic nerve damage
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Neovascular glaucoma: A painful
condition where new blood vessels develop and block the regular
release of fluid from the eye
If there is significant damage to
the eye from radiation, the eye may need to be removed.
Laser therapy
This procedure uses heat in the form of a laser to shrink smaller
tumors. It may also be called thermotherapy or transpupillary
thermotherapy (TTT). This treatment potentially has fewer side
effects than surgery or radiation.
Clinical trials
Doctors are always looking for better ways to treat patients with
eye cancer. A clinical trial is a way to test a new treatment in
order to prove that it is safe, effective, and possibly better than
a standard treatment. Patients who participate in clinical trials
are among the first to receive new treatments before they are widely
available. However, there is no guarantee that the new treatment
will be safe, effective, or better than a standard treatment.One
clinical trial that has shaped how intraocular melanoma is treated
is the
Collaborative Ocular Melanoma Study (COMS).
Patients decide to participate in clinical trials for many reasons.
For some patients, a clinical trial is the best treatment option
available. Because standard treatments are not perfect, patients are
often willing to face the added uncertainty of a clinical trial in
the hope of a better result. Other patients volunteer for clinical
trials because they know that this is the only way to make progress
in treating eye cancer, such as finding new therapies. Even if they
do not benefit directly from the clinical trial, their participation
may benefit future eye cancer patients.
In order to join a clinical trial, patients must complete a learning
process known as informed consent. During informed consent, the
doctor should list all of the patient's options, so that the person
understands the standard treatments, and how the new treatment
differs from the standard treatment. The doctor must also list all
of the risks of the new treatment, which may or may not be different
than the risks of standard treatment. Finally, the doctor must
explain what will be required of each patient in order to
participate in the clinical trial, including the number of doctor
visits, tests, and the schedule of treatment. Learn more about
clinical trials.
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