b1 b2 a Figure 1: Inclusion and Exclusions. Included eyes had (a) juxtafoveal tumor (yellow box) encroaching on the fovea with preserved foveal pit (yellow arrow) without subretinal tumor on OCT (b) Perifoveal tumor (blue box) encroaching the fovea with loss of foveal pit (b2) or preserved foveal pit & underlying tumor (b1) on OCT. Excluded eyes had (c1-2) foveal tumor (green box) without potential for visual salvage, due to total involvement of a 2 DD circle circumference centered over the fovea; or (d) extra-foveal tumor (red box) with excellent potential visual outcome due to non-involvement of 2 DD circle c1 c2 d

a b c Figure 2: Sequential laser crescent method. a) Initial (yellow box)tumor and 532 nm laser photocoagulation from crescent-shaped anti-foveal edge (C1) including outer tumor boundary with the adjacent retina; smaller crescent shaped tumor area (C2) moving closer to the fovea, photocoagulated using 810 nm laser; fovea was avoided. b) Subsequent (green box) scarring of outer boundary noted photocoagulation (C1 and C2) repeated with smaller crescents, c) until either a flat scar or totally calcified lesion or a combination was reached (blue box); OCT (green line) shows preserved foveal pit (yellow arrow) without underlying tumor with retinoschisis between retinal layers overlying the calcific tumor. C1 C2

a Figure 3: Outcome of SLC with juxtafoveal tumors. Yellow box: a) eye with fish-flesh regressed juxtafoveal tumor (upper row) after 4 cycles of systemic chemotherapy; OCT (green line) showed preserved foveal pit (yellow arrow) without underlying tumor; b) after SLC (lower row), fish flesh regressed tumor was replaced by flat scarring except where calcified. The foveola tumor distance (red line) increased post SLC. Red box: c) juxtafoveal tumor d) successfully managed with SLC with preserved foveal pit and increased foveola tumor distance. b c d

X * a b c Figure 4: Recurrences in SLC of perifoveal tumors. (Yellow box, above) a) Pre SLC eye with a fish- flesh regressed perifoveal tumor with foveal center (yellow arrow) over tumor on vertical and horizontal OCT scans; the 2 DD circle indicated perifoveal retina free of tumor and potential good visual outcome. b) After SLC: tumor scarring and flattening in the upper half but regrowth in the lower half (middle column); regrowth easily perceived in relation to the three vessels crossing over the tumor (*). c) Recurrence treated with 4 cycles of IAC and more laser; tumor reduction achieved with preserved fovea, reduced subretinal tumor, retinoschisis (OCT). (Red box, below) d) perifoveal tumor treated with laser shows e, f) recurrence (X) in that failed IAC and plaque irradiation; the eye was enucleated with refractory tumor. d e f

Figure 5: secondary macular changes after SLC treatment Figure 5: secondary macular changes after SLC treatment. a-c) Retinoschisis was the most common secondary change were perifoveal retinal layers showed retinoschisis in both juxtafoveal (a-b) and perifoveal tumors (c). Other changes included d) foveal atrophy and e) loss of foveal contour secondary to epiretinal membrane. Loss of the photoreceptor inner segment outer segment (IS-OS) junction was noted in 64% of juxtafoveal tumors (a, b and d) while 36% showed preserved Is-OS junction (e). (f) regressed tumor with overlying preserved fovea and retinal layers that show retinoschisis with minimal sub retinal fluid collection. The final visual acuity in these eyes was 0.1, 0.4, 0.25, 0.16, 0.5 and 0.05 respectively.