IMPORTANT OPHTHALMIC TUMOURS MICHAEL E GIBLIN FRANZCO ASIA 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 pole Thickness < 3.5mm

Melanoma treatment options Observation TTT Local resection Base < 10mm Anterior to equator

MM treatment options Observation TTT Local resection Radioactive plaque therapy Base <15(18)mm Thickness < 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