Surgery is used to treat some intraocular melanomas but is not used to treat intraocular lymphoma. It is used less often than in the past as the use of radiation therapy has grown.
The type of surgery depends on the location and size of the tumor. Patients are under general anesthesia (in a deep sleep) during these operations, and they usually leave the hospital 1 or 2 days afterward. The operations used to treat people with melanoma include:
Iridectomy: Removal of part of the iris. This operation may be an option for very small iris melanomas.
Iridotrabeculectomy: Removal of part of the iris, plus a small piece of the outer part of the eyeball. Small iris melanomas may be treated with this technique.
Iridocyclectomy: Removal of a portion of the iris and the ciliary body. This operation is also used for small iris melanomas.
Resection: Doctors in some cancer centers may try to surgically resect (remove) a melanoma of the ciliary body or choroid. This can be done for small melanomas but it is hard to remove the tumor without damaging the rest of the eye. This can lead to severe vision problems.
Enucleation: Removal of the entire eyeball. This is used for larger melanomas (T4 or large T3 tumors), but it may also be done for some smaller melanomas if other treatment options would destroy useful vision in the eye anyway. During the same operation, an orbital implant is usually put in to take the place of the eyeball. The implant is made out of silicone or hydroxyapatite (a substance similar to bone). It is attached to the muscles that moved the eye, so it should move the same way as the eye would have. Within a few weeks after surgery, you visit an ocularist (a specialist in eye prostheses) to be fitted with an artificial eye that will match the size and color of the remaining eye. The artificial eye is a thin shell that fits over the orbital implant and under the eyelids. Once the eye is in place, it will be hard to tell it apart from the real eye.
Possible risks and side effects of surgery
All surgery carries some risk, including the possibility of bleeding, infections, and complications from anesthesia.
Surgery on the eye can lead to the loss of some or all of the vision in that eye. Enucleation results in complete and immediate vision loss in that eye. Other surgeries can also cause problems leading to a loss of vision, which can occur later on. In some cases, vision may have already been damaged or lost because of the cancer.
Removal of the eyeball (enucleation) obviously can affect a person's appearance. As noted above, an artificial eye can be put in place to help minimize this.
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