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January 2001

Retinal Vasoproliferative Tumors: A Conservative Approach

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001

Arch Ophthalmol. 2001;119(1):145-146. doi:

In reply

I thank Dr Tripathi for his comments and question on the necessity of a second surgical procedure for removal of the ruthenium plaque when histological confirmation of vasoproliferative tumor was noted in the 2 cases we presented in the April 2000 issue of the ARCHIVES. In hindsight, his approach may be perfectly acceptable; however, because these were the first 2 tumors of their kind to be detailed histologically, there was no clinical confidence in the diagnosis prior to the report. Therefore, because the assumption of malignant melanoma had to be maintained, the application of a ruthenium plaque was entirely justified. Although the removal of the plaque certainly required additional anesthetic time, it was a relatively swift exercise. It is much easier to execute than the alternative procedure in which, in the absence of histological confirmation, no plaques would be applied to a tumor site on clinical grounds alone. This alternative surgical procedure can be loosely defined as an excisional biopsy, and it could result in more protracted care for patients with malignant melanoma. As many as 99% of all primary intraocular tumors in adults have been confirmed as choroidal malignant melanoma.1 Therefore, this procedure would result in many patients having at least 3 anesthesia inductions rather than the usual 2. I could also speculate that because both patients had an improvement in their visual acuity and the remainder of the retinal pattern improved, the exudative response to the local tumor may have benefited from the application of a radiotherapeutic source. Work on subfoveal neovascular membranes has supported this theory and stimulated a significant amount of research.2

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