Choroidal melanoma treatment: a shift towards vision preservation
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 3 (2024),
25 January 2025
,
Page 136-144
https://doi.org/10.51329/mehdioptometry208
Abstract
Background: Choroidal melanoma is the most common primary intraocular malignancy in adults, and is known for its aggressive nature and potential for metastasis. Historically, enucleation was the primary treatment, which resulted in significant morbidity and psychological distress. Recent advances have led to a paradigm shift towards vision-preserving therapies. This review aimed to explore advances in choroidal melanoma treatment and their impact on patient care and quality of life.Methods: For this narrative review, we conducted a literature search of major databases, including PubMed/MEDLINE, Embase, and Scopus, from January 1, 1998, to December 30, 2024. The search strategy employed the following keywords: “choroidal melanoma,” “vision preservation,” “plaque brachytherapy,” “proton beam therapy,” “stereotactic radiosurgery,” “enucleation,” “ocular oncology,” “retinal health,” “visual acuity,” “quality of life,” “computational intelligence,” and “AI (artificial intelligence).” We included English-language studies of any design focusing on choroidal melanoma treatment, particularly treatment involving vision-preserving strategies.
Results: Advances in vision-preserving therapies, such as plaque brachytherapy, proton-beam irradiation, and stereotactic radiosurgery, have revolutionized the management of choroidal melanoma. These modalities offer improved patient outcomes by reducing the need for enucleation and preserving visual acuity. Plaque brachytherapy achieves high tumor-control rates with minimal side effects, while proton-beam irradiation provides precise tumor targeting, which is particularly beneficial for large tumors. Stereotactic radiosurgery is effective for smaller tumors, but may result in decreased visual acuity over time. Emerging therapies, such as Bel-Sar (AU-011), show promise in controlling tumor growth while preserving vision. The ability of Bel-Sar to control tumors while preserving vision could provide patients with a more favorable prognosis and improved quality of life. Immunotherapy holds significant promise, particularly with the potential for use of immune checkpoint inhibitors and vaccine therapies. Additionally, artificial intelligence (AI) is becoming increasingly important in the management of choroidal melanoma.
Conclusions: The shift from enucleation to vision-preserving therapies has significantly improved outcomes and quality of life for patients with choroidal melanoma. Future research should focus on optimizing current therapies for better visual acuity preservation and on exploring new targeted therapies to enhance tumor control while minimizing side effects. Moreover, studies on AI applications for managing this sight- and life-threatening eye condition could significantly transform treatment outcomes.
Keywords:
- choroidal melanoma
- enucleation surgery
- vision
- radioisotope brachytherapy
- radioisotope plaque therapy
- proton beam radiation therapy
- targeted molecular therapy
- computational intelligence
- AI (artificial intelligence)

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