IMPORTANT OPHTHALMIC

TUMOURS

MICHAEL E GIBLIN FRANZCOASIA PACIFIC SOCIETY OF OCULAR

ONCOLOGY AND PATHOLOGY

Uveal melanoma

Iris melanoma

• Large• Diffuse• Rapid growth• Hyphaema• Refractory glaucoma• Subjacent ciliary body

involvement

• Symptoms• Thickness > 2mm• Orange pigment (lipofuscin)• Growth• Subretinal fluid• Peripapillary location

Choroidal naevus versus melanoma

MM treatment options

• Observation• Transpupillary laser thermotherapy (TTT)

Posterior poleThickness < 3.5mm

Melanoma treatment options

• Observation• TTT• Local resection

Base < 10mmAnterior to equator

MM treatment options

• Observation• TTT• Local resection• Radioactive plaque therapy

Base <15(18)mmThickness < 8mm

Ruthenium 106

Iodine 125

MM treatment options

• Observation• TTT• Local resection• Radioactive plaque therapy• Proton beam/helium ion irradiation• Stereotactic R/T; LINAC/gamma knife

MM treatment options

• Observation• TTT• Local resection• Radioactive plaque therapy• Proton beam/helium ion irradiation• Sterertactic radiotherapy• Enucleation

Base > 18mm

BAP1

• BAP1 = BRCA Associated Protein 1

• Recessive cancer suppression gene

• Located on 3p21.1• Associated with monosomy 3• Inactivating mutation leads to liver metastasis

Circumscribed choroidal haemangioma

High internal reflectivity

Metastatic tumours

•May be multifocal•Characteristically posterior to equator•Usually amelanotic•Leopard-skin RPE spotting•Sub-retinal fluid if active•Treat if sight affected•Lung ca. Choroidal metastasis may precede detection of primary

Retinoblastoma

•Aim for earlier detection•Chemotherapy mainstay of treatment for hereditary retinoblastoma

• Incresing role for intraarterial chemotherapy