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UVEAL TUMOURS

Classification
Uveal tumors can be classified according to
their location, etiopathology, histopathology,
histogenesis, genotype, and various other
ontological methods.
Etiopathogenic classification;- This system
categorizes uveal tumors as congenital,
traumatic, inflammatory, neoplastic,
degenerative and idiopathic. This classification
is far from perfect.
The anatomical listing is only approximate

PRIMARY TUMOURS
A} Epithelial tumors
1) Epithelial hyperplasia.
2) Benign tumours: benign epithelioma,
hamartoma.
3) Malignant tumours:
a)medullo epithelioma (dictyoma,
malignant
ciliary epithelioma).
b) papillary cystadenoma
c) neuroblastoma.

B}MUSCULAR :
leiomyoma.
leimyosarcoma.
C}VASCULAR : hemangioma.
D}RETICULOSIS:
lymphoma.
lymphosarcoma.

D}NEURO -ECTODERMAL:
1)schwannian tumours
a)diffuse
neurofibromatosis.
b) neurilemmoma
(neurinoma).
2) melanomata: benign & malignant.

Secondary tumors
Direct extension: carcinoma
melanoma,
retinoblastoma,endothelioma,
meningioma.
Metastatic : carcinoma,
hypernephroma, mal. Melanoma,
chorion epithelioma, sarcoma.

Epithelial tumours
Epithelial tumors of iris & ciliary body
are relatively rare.

As anterior layer of epithelium gives


rise to smooth muscles, as all
gradations of tumour may exists
from epithelioma to leiomyoma.

EPITHELIAL
HYPERPLASIA
Hyperplasia frequently takes the form
of proliferation into the cells of same
type as those of parent epithelium.
The process may often be diffuse, it is
frequently localised so that a discrete
plaque or head up mass is formed
having clinical charact of true
neoplasm.
Hyperplasia of pigment epithelium
may be congenital in origin.

EPITHELIAL
HYPERPLASIA
It usually appears as discrete, flat &
deeply pigmented lesion showing no
tendency to grow, mainly seen on
pupillary margin.
EPITHELIAL hyperplasia of IRIS: simple
hyperplasia of pigmented layer of
posterior surface is particularly after
prolonged iridocyclitis, trauma
(including surgery), glaucoma or
degenerated eyes.

EPITHELIAL
HYPERPLASIA
In primary glaucoma: The epithelial cells
may migrate through the stroma of iris to
apper as velvety black spot on anterior
surface of iris, mainly at collarette.
EPITHELIAL hyperplasia of ciliary body:
Fuch emphasized difference between
simple reactive hyperplasia &
epithelioma. Both this conditions occurs
in blind degenrative eyes.

EPITHELIAL
HYPERPLASIA
Hyperlasia is direct continuation of
ciliary epithelium forming tumour like
masses projecting inwards but
showing no distinct pattern of cells.
In case of old RD the ciliary epithelium
may show hyperplasia near ora
forming plaque may develope into
metaplasic changes.

IRIS CYSTEpithelial cyst


Iris cysts
are lesions
arising
from the
iris
epithelium
mainly or
from
stroma
rarely.
STROMAL

IRIS CYST
Primary epithelial cysts: u/l or b/l.
Solitary or multiple may be brown or
transparent.
location may be at pupillary border or iris
root, occasionally gets dislodged & floats in
AC or vitreous.
Majority of cysts are asymptomatic, rarely
cysts may obstruct vision & requires
treatment with argon laser
photocoagulation.

IRIS CYST
primary stromal cysts:presents in first
year of life.
solitary, unilateral with smooth translucent
anterior wall.
Cysts may suddenly enlarge to cause
secondary glaucoma & corneal
decompensation.
neddle aspiration or surgical excision,
injection of ethanol into the cyst & removal
can also done.

Secondary cysts
Implantation: m/c type originate after
deposition of surface epithelial cells from
conjunctiva or cornea on the iris after
trauma.
Pearls: white, solid lesion with opaque walls
located on stroma, not connected to wound.
Serous: translucent cysts filled with fluid,
connected to wound, frequently enlarge
leading to corneal edema, antr uveitis &
glaucoma.

Secondary cysts
Prolonged use of miotics: b/l
small, multiple cysts located along
the pupillary border. It can be
prevented by concomitant use of
topical phenylephrine
2.5%.
WORM
Parasitic: very rarely cysts may
develop in parasitic infection.

JUVENILE
XANTHOGRANULOMA
Rare idiopathic granulomatous d/s of
childhood.
Involves skin,muscle,stomach, salivary
glands.
Iris involvement cause localised or
diffuse yellow lesion with spontaneous
hyphema, anterior uveitis or glaucoma
TOC: topical steroids.

BENIGN EPITHELIOMA
m/c site is pupillary border, appears
as black/ brown masses with knobby
or convulated surface, periphery of iris
near root is 2nd m/c site.
Histo: madeup of masses of cells
typical of pigment epithelium with
normal nuclei without mitotic activity,
stromal elements may be entirely
absent, tumour may be infiltrated by
blood vessels.

BENIGN EPITHELIOMA
Difference between epithelioma &
melanoma is dense blackness of
former & its usual sharp differentiation
from surrounding.
Management: observation over
sometime, preferably by photography.
If doubt iridectomy is done,many eyes
involved have been excised owing to
the fear of malignancy.

EPITHELIOMA OF CILIARY
BODY
First description of benign epithelioma
was given by Fuch in 1883 in the eye of
70 year female pt having absolute
glaucoma known as Fuchs
epithelioma.
Occurs in wide age group 10 to 90 years
of age, no sex prediction.
Prolonged irritations such as
inflammation, trauma or other intraocular
tumour predisposes their formation.

EPITHELIOMA OF CILIARY
BODY
Tumour is usually small around 1mm
but occasionally reaches to 5mm in
diameter.
Gonioscopy in dilated pupils shows
brown pigmented mass oval or round
in shape lying on the ridge of ciliary
process or in intervening valley.
Histo: high degree of differentiation,
seperated from stroma, may lose its
pigment or become atrophied.

EPITHELIOMA OF CILIARY
BODY
In transitional cases which is
between typical simple growth &
malignant medulloepithelioma have
been reported, this tumour has
cellular growth.

MEDULLO EPITHELIOMA
Fuch classically divided medullo
epithelioma to two groups
A)Resesmbling embryonic retina
DICTYOMATA.
B)Ciliary epithelium (malignant
epithelioma of ciliary body).

DICTYOMA
A.k.a Embryonal medullo-epithelioma.
It is a tumour arising from non pigmented
layer of ciliary epithelium having structure of
embryonic retina.
Never b/l, no multicentric in origin & no
hereditary tendency, young children, present
as u/l buphthalmos/glaucoma/ cataract.
Histo: made up of bands of cells arranged in
one/ several rows forming intricate
convolutions.

DICTYOMA
Dictyoma should be suspected in all
cases of u/l buphthalmos, glaucoma
in child , staphyloma, u/l catarctous
or dislocated lens or nay cyst
formation in the Ac
Management: only treatment of
choice is enucleation.

MALIGNANT CILIARY
EPITHELIOMA
Unlike dictyoma this type is formed by
mature cells.
Involves eyes which have severe
inflammation.
Small dark non translucent nodule
bulging from behind & eventually
appearing over pupillary margin.
Course of tumour is slow & benign eye
becomes atrophic & degenerated.

MALIGNANT CILIARY
EPITHELIOMA
Histo:
a single layer of cell, tube formation
may occur giving the tumour in section
a lace like effect.

Rosette like structures, primitive nerve


fibres formations resembles primitive
optic vesicle.

MUSCULAR TUMOUR
Leimyoma: Reported only in
caucasians, F>M, commonly on lower
half of iris , temporally & on
sphincteric region.
Generally forms a sessile mass on
pupillary margin, pink/ greyish white in
colour.
Difficult to diagnose from a sparsely
pigmented malignant melanoma.

VASCULAR TUMOUR
Haemangiomas are more common in
choroid as compare to iris & ciliary body.
Iris: vascular tumour is localised on the
iris surface, which may give rise to
periodic bleeding.
Choroidal haemangioma is divided into
circumscribed.
diffuse.

CIRCUMSCRIBED
Not associated with any
systemic d/s shows mass within
the choroid, composed of
vascular channels.
Presents in 2nd-4th decades,
u/l blurring of vision, visual field
defect & metamorphopsia.
Hypermetropia+
An oval mass @ posterior pole.
Lesion is 6mm in dia & 3mm
thick.
Can cause RD, RPE degenration
& subretinal fibrosis.

CIRCUMSCRIBED
FA shows spotty
hyperfluorescenc
e in early
arterial phase.
ICGA also
shows
hyperflourescenc
e in early
frames.

CIRCUMSCRIBED
US shows acoustically solid lesionwith
sharp anterior surface.
Treatment: photodynamic therapymay be repeated after few months.
TTT:if lesions are not involving
macula.
Radiotherapy.
Intravitreal anti-VEGF therapy.

DIFFUSE
Affects over half of
choroid
Enlarges very slowly.
Exclusively seen in
patients with sturge
webber syndm.
Presents in 2nd decade
of life despite its
formation @ birth.

DIFFUSE
Fundus appears as deep red tomato
ketchup colour, most marked at posterior
pole.
Localised area of thickening is present,
simulating a circumscribed haemangioma.
USG: shows diffuse thickening.
Complictn: RD, neovascular glaucoma,
retinal cystoid degenratn.
Treatmnt: radiotherapy/ PDT.

CHOROIDAL OSTEOMA
Very rare benign,slow growing
ossifying tumour.
b/L in 25% cases, F>M.
Mature cancellous bone which causes
overlying RPE atrophy.
Presents in 2nd- 3rd decades , yellowishwhite flat, minimally elevated lesion
near disc or posterior pole present.

CHOROIDAL OSTEOMA
FA shows mottled
hyperfluoresecnce & late
staining.
ICGA: early
hypofluorescence.
USG: highly reflective
antr surface & orbital
shadowing.
No malignant potential,
managemant is directed
@ preservation of vision
mainly.

NEUROFIBROMA
Congenital condition representing a
diffuse proliferation schwann cells of
the peripheral nerves.
HISTO: increase in thickness of
choroid & ciliary body, pear shaped
deformity of the pupil resembling
colobomata may occur.
Rx: Excision------ enucleation.

NEURILEMMOMA
Benign encapsulated tumour of
nerve sheath.

Tumour composed of schwann cells


arranged in interlacing cords with
palisading of the nuclei.

METASTATIC TUMOUR
Choroid is m/c site accounting for about
90% followed by iris & ciliary body.
Most frequent primary site is breast &
bronchus.
A fast growing creamy white lesion with
indistinct margins most frequently at
posterior pole may be present.
Deposits are multifocal, may cause RD.

METASTATIC TUMOUR
Management
1, Observation.
2, Radiotherapy.
3, TTT (transpupillary
thermotharapy).
4, Systemic therapy for 10
tumour

RETICULOSIS
Any part or whole of uveal tract may
be involved & ocular lesion may be
B/L.
In anterior segment: severe
iridocyclitis, nodular mass in AC.
In posterior segment: pan uveitis,
RD, vision fails rapidly.

RETICULOSIS
HISTO: lymphocytic cells arranged
either diffusly, in reticular cells large
round oval nuclei & small cytoplasmic
process resembling the cells of
germinal centre of lymph follicles are
present lying within the network of
reticulum.
MANAGEMENT: palliative, in some cases
enucleation is required.

RETICULOSIS
MULTIPLE MYELOMA: abnormal
plasma cells in bone marrow.
deposition of plasma cells in the
tissue particularly in retina / optic
nerve & bony orbit.

UVEAL NEVUS
The uveal nevus is a benign tumour that
arises from melanocytic cells derived from
the neural crest.
m/c in whites, aprox 20% develop at least
one choroidal nevus >50yrs of age, M=F.
1 in 4000-5000 undergoes malignant
changes.
Asymptomatic may cause visual loss in
macular choroidal nevi.

IRIS NEVUS

IRIS NEVUS
IRIS NEVUS :< 3mm in diameter, <
0.5mm thick,pupillary peaking, focal
ectropion iridis or both, abnormal iris
vasculature.
Choroidal nevus:small grey to brown
choroidal tumour, < 5mm in diameter, <
1mm in thickness, causes
blurred/distorted vision serous subretinal
fluid, cystic degenration of retina involving
macula or choroidal neovascularization.

MELANOCYTOMA
Special type of nevus
melanocytomaof optic disc.
Composed entirely of maximally
pigmented polyhedral nevus cells
(magnocellular nevus cells).
Lesion appears striated because of
insinuation of pigment cells between
axons in the nerve fibrelayer which may
inturn causes visual field defect.
Magnocellular nevus can occur in
choroid, ciliary body & iris.

MELANOCYTOMA

DIAGNOSIS
B-scan
Fluoresceine angiogrphy &
indocyanine green angiography.
Documented photogrphy shortly
after detection.
FNAC can be used to determine
larger tumours >1.5mm thick using
trans vitreal bent neddle technique.

DIAGNOSIS
Neurofibromatosis 1 patients comes
with multiple uveal nevi in both eyes,
become evident @ 10-15 yrs of age.
Histo: spindle nevus cells are fusiform
melanocytes that typically have a
relatively small nucleaus.
Magnocellular nevus: plump
polyhedral melanocytes containing
numerous large intra cytoplasmic
melanin granules.

MANAGEMENT
Photographic documentation/ usg
documentation & periodic evaluation.
For every small tumours 1-2 yearly
followup, slightly larger 6-12 months
followup, mal changes 1-3 months.
Focal laser therapy can be given in nevi
causing blurred visison.
In choroidal neovascularisation focal
obliterative laser therapy/
photodynamic therapy can be given.

Course / outcome
In IRIS LESION consider benign if:
1)Small size <3mm in dia, 0.5mm thick
2)cohesive surface
3)Absence of pig dispersion
4)lack of pupillary peaking.
5)ab of ectropion iridis.
6) Ab of cataract, vascularity.
Lack of symptoms & enlargement.

Course / outcome
In choroidal lesion consider benign if:
1)Small size <5mm dia, 1mm thick.
2)Homogenous gray brown surface.
3) Feathered margins blends into
surrounding normal choroid.
4)Drusen/retinal pigment clumping &
migration.
5) Ab of lipofuscin pig on surface lesion/
subretinal fluid.
6) No sudden increase in size.

MALIGNANT MELANOMA

Malignant neoplasm arising from


neuroectodermal melanocytes. m/c
intraocular tumour in whites.
Key features are metastasize
hematogenously, m/c involve liver,
choroid is commonly involved.
Incidence is 1 in 2000-5000 white
individuals, 15 to 50 times less
common in blacks, m/c in men.

MALIGNANT MELANOMA
Uveal tumours confined to iris appears
to be substantially less malignant as
compare to choroidal melanomas.
Extent of tumour & management is
different for iris melanoma & ciliary
body/ choroidal melanomas.
For this reason these two general
forms are discussed seperately.

IRIS MELANOMA
Presents as an spot on the iris with
no symptoms.
>1mm thick is main concern for its
malignancy.
Dispersion of tumour cells, pigments,
may cause increase in IOP, pupillary
peaking ectropion iridis , iris splinting
may present.

Diagnosis
1.Transillumina
tion test.
2. photography.
3.Fluorescence/
indocyanine
angiography.
4.B-scan.
5.Biopsy;
incisional/ fnac.

IRIS MELANOMA
Histo: composed of atypical
melanocytic cells, larger nuclear to
cytoplasmic ratio.
Tumour cells have a fusiform shape &
mild atypical spindle melanoma cells.
Those that have more spherical &
more pronounced anaplasia are
called as epithelioid melanoma cells.

MANAGEMENT
Small melanomas should be observed without
intervention.
Excision: iridectomy/ irideocyclectomy is
done.
Plaque radiotherapy/ photon beam irridiation
performed in small number of cases but
appears to be effective in short term followup.
Enucleation: for large iris melanomas,
extensive seeding, transcleral spread, blind
painful eye.

course
Iris tumour grows relatively slowly.
Replaces porportion of iris & ciliary
body.
Can cause secondary glaucoma.
Post excision patient must be
followed for every 6 months for first
2-3 years & yearly there after.

CHOROIDAL/CILIARY
MELANOMAS
Most cases
associated
with ocular
pain, dilated
sentinal
vessels,
extend
through
sclera
epibulbar
mass

CHOROIDAL/CILIARY
MELANOMAS
20% of choroidal melanomas breaks
through bruchs membrane & RP to form a
nodular eruption.
They exhibits prominenet clumps of orange
lipofuscin pigment on their surface.
May be associated with non
rhegmatogenous RD clear, serous, shifting
subretinal fliud.
VH may be present.

CHOROIDAL/CILIARY
MELANOMAS
In ciliary body melanomas appears
elevated, nodular, dark brown mass
in peripheral fundus.
The surface of the tumor may
contain yellow drusen or
orange lipofuscin deposits

Clinical features
asymptomatic
incidentally during ophthalmoscopy .
In general, the more anterior their origin, the longer the delay of
any symptoms.

Blurred visual acuity


growth of the melanoma into the subfoveal retina
cystoid macular edema disruption of choroidal circulation
ischemia degeneration of retinal photoreceptors The retina
overlying the tumor separates into cystoid spaces and larger
schisis cavities.
Retinal detachment - Exudation of fluid into the subretinal space
retinal detachment enlarge the field loss can lead to total
retinal detachment

vitreous hemorrhage - Erosion of the melanoma into blood


vessels in adjacent tissues, or areas of necrosis within the tumor
cataract involvement of lens

Paracentral scotoma
if the tumor affects the perifoveal retina .

visual field loss Painless and progressive as peripheral

melanoma grows
Floaters when areas of necrosis within the tumor or adjacent
structures produce vitreous hemorrhage or hyphema.

Severe ocular pain Occasionally when they impinge into


posterior ciliary nerves.
can also cause pain secondary to high intraocular pressure from
acute angle-closure glaucoma .

History of weight loss, marked fatigue,


cough, or change in bowel or bladder
habits, should prompt consideration of
primary non-ocular malignancy with
choroidal metastasis

DIAGNOSIS
The diagnostic error rate in the COMS was only
0.48%.
Misdiagnoses occur in less than 4% of
enucleated eyes at tertiary referral centers.
The diagnostic error rate in the COMS, however,
was measured under ideal conditions; all tumors
were well visualized and photographed. Patient
were excluded from the COMS if the ocular
media was opaque. In real-world situations, the
misdiagnosis rate for posterior melanoma may
be greater than that reported by the COMS

A-scan ultrasound
tumors more than 2-3 mm thick.
characteristically shows an initial prominent spike, followed by lowto-medium internal reflectivity. Vascular pulsations can be seen as
fine oscillations of the internal spiking pattern within the tumor.
Standardized ultrasonography has a diagnostic accuracy of more
than 95%.

B-scan ultrasound to help establish the diagnosis, to evaluate

possible extraocular extension, and to estimate tumor size for


periodic observation and plan therapeutic intervention
Low-to-medium reflectivity
Excavation of underlying uveal tissue
Internal vascularity
An acoustic quiet zone at the base of the tumor called acoustic
hollowing

Fluorescein angiography do not show

pathognomonic signs of choroidal melanoma but can help


point to its diagnosis.
Small choroidal melanomas may show fluorescein
angiographic changes similar to some choroidal nevi, as
follows: ranging from normal angiography to hypofluorescence
secondary to blockage of background fluorescence.
Larger melanomas may show a patchy pattern of early
hypofluorescence and hyperfluorescence followed by late
intense staining.
intrinsic vascularization, visible throughout the angiogram.
The angiographic sign called "double circulation" pattern
refers to simultaneous fluorescence of retinal and choroidal
circulation within the tumor. When it occurs, it is fairly
distinctive of choroidal melanomas

Early fluorescein
angiogram of
choroidal
melanoma
showing
intrinsic
vascularity

CT scan orbit
is more expensive than ultrasound and
currently is not as sensitive.
It is useful to see extraocular extension and may help
differentiate between choroidal or retinal detachment
and a solid tumor.
Choroidal melanoma shows enhancement with
contrast, where as exudation does not.
CT scan also is very sensitive detecting calcium, a
feature of some tumors that are different than uveal
melanoma (characteristically choroidal osteoma).

Fine needle and incisional biopsy


usually are not required
to distinguish amelanotic melanomas from metastatic
tumors, and if results from other ancillary tests are
equivocal.
accuracy of more than 95% in tumors larger than 3 mm.
Incisional biopsy is more invasive and may have more
associated complications, but it has less false-negative and
false-positive results.
Risk of spread of cancerous cells with needle biopsy is small
for choroidal melanoma (unlike retinoblastoma). Follow
biopsy by prompt treatment to avoid extrascleral extension.

Histologic evaluation - after enucleation can confirm


the diagnosis and evaluate prognosis.

Three distinct cell types are recognized:


Spindle A - elongated nuclei and uncommonly have
mitotic figures
Spindle B - prominent nucleolus
found more commonly, have an elongated profile but are
slightly larger than spindle A cells
Epithelioid most aggressive behavior and carries a
poorer prognosis for the patient's long-term survival
highly anaplastic, poorly cohesive, and have considerable
frequent mitotic figures.

Modified callender
classification
Histologically can be divided into 3
types;
1.Spindle cell melanoma- good
prognosis.
2.Mixed cell melanoma- intermediate.
3.Epitheloid cell melanoma- worst
prognosis.

Prognosis
30-50% of patients with choroidal melanoma will die within 10
years from diagnosis and treatment
tumor features found to correlate with increased mortality,
larger size,
anterior location,
transscleral extension,
growth through Bruch's membrane,
optic nerve extension,
lack of pigmentation, and
histologic characteristics such as mitotic activity and cell type

Surgical Care:
Enucleation -large (basal diameter >15 mm and height
>10 mm) and complicated tumors, which compromise
visual function, and where other therapies tend to fail.
Because of potential release of malignant cells into the
bloodstream, manipulation of the globe should be kept
to a minimum.
Particular care has to be taken to avoid perforation of
the globe during surgery. If transcleral extension is
found, the tumor should be removed in one piece, pre
enucleation radiotherapy is given, followed by
cryotherapy of the involved orbital soft tissues.

Plaque brachytherapy
alternative to enucleation for medium size posterior uveal
melanomas (<10 mm in height and <15 mm in diameter).
Iodine 125(USA), preferred because of its
lower energy emission (lack of alpha and beta rays),
good tissue penetration, and
its commercial availability.
Mechanism damage of DNA in cancerous cells and tumor
vessels, with consequent tumor necrosis and regression.
A computerized calculation is used to determine the dose
and duration of plaque application for a radiation delivery
of approximately 400 Gy to the base and 80-100 Gy to the
apex of the tumor.

A margin of 2 mm over the largest tumor basal dimension is


adequate.
Postoperative imaging confirmation of correct plaque localization
is required. Radioactive plaques are left in place for 3-7 days.
The goal of successful treatment is to achieve arrest of tumor
growth or regression in size.
Local recurrence, usually requiring enucleation, occurs at a rate
of about 12-16%.
complications

cataract,
rubeosis,
scleral necrosis,
keratopathy,
radiation retinopathy, and
optic neuropathy but at a reduced rate compared with external beam
irradiation

External beam irradiation using charged particles,

either protons or helium to treat medium size choroidal


melanomas (<10 mm in height and <15 mm in diameter),
although it has been used for larger tumor It has similar
indications and success rates to plaque brachytherapy.
radiopaque tantalum rings usually are sutured to the sclera
to serve as reference markers for alignment of the radiation
beam. A collimated beam delivers about 70 Gy, divided
usually in 5 sessions.
Vital ocular structures are avoided through careful positioning
of the head and eye. Irradiation causes damage of DNA in
cancerous cells and tumor vessels, with consequent
tumor necrosis and regression..
survival rate comparable to those treated by
enucleation.

Small choroidal melanomas, when they are located

away from the fovea and are less than 3 mm in thickness


Laser photocoagulation - to seal off the blood supply to
the tumour and destroy it
Transpupillary thermotherapy
Photodynamic Treatment
Animal study
melanin precursors become extremely phototoxic in
melanoma tumor cells when activated with certain light
sources
No additional phototoxic agents are administered
differs from conventional photodynamic therapy in that it
uses pulsed, longer wavelength light

The Collaborative Ocular


Melanoma Study
initiated in 1986
long-term, multicenter, randomized
controlled trials
conducted in 43 clinical centers
located in major population areas of
the United States and Canada

SMALL

MEDIUM

LARGE

Typeofstudy

Nonrandomized, Prospective
randomized
prospective
followup
clinicaltrial
study

Prospective
randomized
clinicaltrial

Numberof
patients
Sizeof
melanomas
includedin
study

204

1317

1003

Apicalheight:
1.0to2.5mm
Largestbasal
diameter:5mm

Apicalheight:
2.5to10.0mm
Largestbasal
diameter:5to
16mm

Apicalheight:
10.0mmor
larger
Largestbasal
diameter:
16mmor
larger

Findingsofstudy
baselinecharacteristicsassociatedwithgrowthofsmalltumors
21%grewby2years
31%grewby5years
Characteristicsassociatedwithgrowth:initialtumor,thicknessanddiameter,
presenceoforangepigment,absenceofdrusen,absenceofRPEchanges

Noclinicallyorstatisticallysignificantdifferenceinsurvivalratesbetween
I125Brachytherapyvsenucleationfortreatmentofmediumtumorsforup
to12yearsaftertreatment
NosignificantdifferenceinsurvivalratesbetweenPreenucleationradiation
vs.enucleationalonefortreatmentoflargetumors.5yearsurvivalrates60
percent
Ageandlargestbasaldiameterofthetumoraretheonlyfactorsthataffect
prognosis

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