ÖZET
Amaç: Koroid melanomu (KM) tedavisinde diod laserle transpupiller termoterapinin (TTT) etkinliginin incelenmesi.
Gereç ve Yöntem: Tümör birimine basvuran, klinik muayene, fundus flöresein anjiografi (FFA) ve ultrasonografi (USG) ile koroid melanomu tanisi konmus, en genis taban çapi 13 mm, kalinligi 6 mm'den daha az olan 15 olguya 810 nm diod laser ile ortalama 2-3 kez TTT uygulandi. Her TTT uygulamasinda 2-3 mm isin çapi ve 400-800 mW arasinda güç kullanildi, süre 8 ile 28 dakika arasinda tutuldu. Tedavi sonrasi kontrollerde tümör boyutu izlendi, USG ile tümör kalinligi ölçüldü. Tüm hastalar tedaviye yanit, olasi komplikasyonlar ve nüks açisindan degerlendirildi. En az 36 ay izlenmis olan 9 olgunun sonuçlari degerlendirildi.
Bulgular: Ortalama en genis taban çapi 7.2 mm (5-12 mm), tümör kalinligi 3.5 mm (2-6 mm), optik diske uzaklik 2.4 mm (0-6 mm), foveolaya uzaklik ise 3.8 (0.5-8 mm) idi. Hastalar ortalama 50.6 ay (36-66 ay) izlendi. Son kontroldeki ortalama tümör kalinligi 1 mm (0-2.5 mm) idi. En sik görülen komplikasyonlar vitreusa kanama (4 olgu), katarakt (2 olgu), iris atrofisi (2 olgu) ve pigment dispersiyonu (1 olgu) idi.
Sonuç: Transpupiller termoterapinin koroid melanomu tedavisinde kullanimi ile uzun dönemde basarili sonuçlar alinmistir. Primer ve sekonder tedavi olarak kullanilabilir.
Anahtar Kelimeler: Diod laser, Koroid melanomu, Transpupiller termoterapi
Diode Laser Transpupillary Thermotherapy in
the Treatment of Choroidal Melanoma
SUMMARY
Purpose: To evaluate the effectiveness of diode laser transpupillary thermotherapy (TTT) in the management of choroidal melanoma.
Material and Methods: Fifteen patients having choroidal melanoma with the largest tumor base diameter less than 13 mm and the tumor thickness less than 6 mm were given two-three session of TTT. The parameters used were energy levels of 400-800 mW, duration of 8 to 28 minutes, and spot size of 2-3 mm. The tumor thickness was measured with A and B mod ultrasonography. Nine patients who were followed-up for at least 36 months were evaluated.
Results: The mean largest tumor base diameter was 7.2 (5-12) mm. The mean tumor thickness was 3.5 (2-6) mm. The mean distance from the optic disc was 2.4 (0-6) mm, and the mean distance from the foveola was 3.8 (0.5-8) mm. The mean follow-up was 50.6 (36-66) months. The mean tumor thickness at last follow-up examination was 1 mm (0-2.5). The most common complications were vitreous hemorrhage (4 cases), cataract (2 cases) and iris atrophy (2 cases).
Conclusion: Transpupillary thermotherapy is an effective treatment in choroidal melanoma in the long term. It can be used as a primary or secondary treatment.
Key Words: Choroidal melanoma, Diode laser, Transpupillary thermotherapy
