Surgery for Intraocular Melanoma

Doctors may perform a procedure called an iridectomy biopsy to obtain a tissue sample from a tumor in the iris, the pigmented part of the eye. This procedure is also used to obtain a sample from a tumor in the ciliary body, the middle part of the eye that extends into the iris. An iridectomy is performed in the hospital using general anesthesia.

Eye cancer specialists at NYU Langone developed an aspiration cutter technique to perform iridectomy. In this technique, the doctor makes a tiny incision in the transparent covering of the eye, known as the cornea, and suctions out small pieces of tumor, along with some of the surrounding iris. The incision usually heals on its own. A sample of the tumor is examined under a microscope to determine whether it’s likely to spread.

If the biopsy reveals that the tumor is a melanoma, the tumor can be destroyed using plaque brachytherapy, a type of radiation therapy. This technique avoids surgical removal of the tumor, which can cause a loss of pupil function—the part of the eye that lets in light—and increases the risk of glare.

Enucleation, or removal of the eye, is only recommended if a tumor is too large for vision-sparing treatments, such as radiation therapy. It may also be appropriate if you already have significant vision loss or your doctor is concerned that the tumor may spread.

This procedure is performed on an outpatient basis with general anesthesia. After surgery, the doctor removes a small sample of the tumor to analyze the appearance and genetic characteristics of the tumor cells. This can help determine the tumor’s risk of spreading.

Most people return home after enucleation surgery with a patch over the affected eye, which is worn for up to five days. About a week after the surgery, the eye cancer specialist removes the bandage and places a temporary, plastic prosthetic eye in the socket.

About six weeks after surgery, an ocularist, who makes and custom-fits prosthetic eyes, fits you for a permanent prosthetic eye that better matches the size and color of the other eye.