Upon possibilities of simultaneously “radical and sparing” endovitreal removal of choroidal melanoma

Relevance . The endoresection of the choroidal melanoma (CM) is carried out from its top to the base with the formation of surgical coloboma within the healthy choroid visible in the operating microscope, which does not guarantee the absence of residual tumor cells in it at the microscopic level. Excision of the choroid with a large amount of healthy tissues leads to a risk of unnecessary resection of functionally significant tissues with corresponding loss of vision, especially in juxtapapillary and paramacular localization of CM. Purpose : to develop a method to increase the radicality of endovitreal removal of the choroidal melanoma while achieving the maximum functional result. Material and methods . At the basis of the “radical and sparing” endovitreal removal of CM lays the principle of micrographic Mohs-surgery used in the treatment of skin cancer. When CM of paramacular localization is mushroom-shaped, the tumor peak often hangs over the macular zone and prevents its visualization and does not allow to determine true boundaries of the CM base in this area. In this situation, it is possible to carry out an endoresection of CM under video endoscopic control. Results . According to the proposed method, 3 patients were operated: 2 men and 1 woman. All patients in the pre-operative period had exudative retinal detachment, in 1 of them it was vesicular. For the maximum period of observation, all 3 patients are alive, in none of them metastatic lesions and tumor recurrence were detected. All eyes have been preserved. The best corrected visual acuity was: in patient No 1 – 0.3; in patient No 2 – 0.4; in patient No 3 – 0.1. Conclusion. The proposed treatment method makes possible to carry out the most radical endovitreal removal of CM, which at the same time is sparing for functionally significant healthy surrounding tissues with a decrease in intra- and postoperative complications.