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Tumors in the eye usually are caused by cancers that spread from other parts of the body, especially the breast. Leukemia and other malignancies also may occur in the eye. However, two other types of tumors arise within the eye itself: retinoblastoma in children and melanoma in adults.
Specialists at the Wilmer Eye Institute at Johns Hopkins, consistently ranked among the best in the United States by U.S. News and World Report, treat eye cancers with the latest therapies, many pioneered by Wilmer physicians.
Choroidal melanoma is the most common primary malignant eye tumor in adults. A series of multi center-randomized trials, supported by the National Cancer Institute and the National Eye Institute, titled the Collaborative Ocular Melanoma Study (COMS), was coordinated at the Johns Hopkins' Wilmer Eye Institute.
The trials were divided according to tumor size:
For large tumors, patients are randomized to enucleation (removal of the eye) with or without preoperative external beam radiation (PERT). 1003 patients were enrolled until recruitment ceased in December, 1994 (when the 1,000 patient sample size was met). The intial five year mortality results were announced in June, 1998 in the American Journal of Ophthalmology and local ocular complications in the September issue. At five years, survival rates are comparable but local complications are reduced with PERT--there are fewer local recurrences. Given the cost, inconvenience and unknown long term effects of PERT, as recurrences were extremely rare in each group, we expect most doctors will not recommend PERT unless longer followup demonstrates a survival advantage.
For patient with medium size tumors, approximately 1,200 patients have been randomized as of 1996 to either enucleation or local radiation brachytherapy with an I-125 plaque source.
For small tumors, patients are treated with a trial of prompt 1-125 plaque treatment versus deferral of treatment unless there is documented growth in the discussion phase.
Retinoblastoma, occuring mainly in children, has a high cure rate for cancers found early. Treatments vary depending on the where the tumor has spread beyond the eye.
Melanoma damages vision and tends to spread via blood vessels to distant organs. Some tumors in the eye are visible upon examination, others require diagnostic tests. For children, much of that testing takes place in a playroom-like setting, using techniques designed to be child-friendly.
Using the latest technology, such as ophthalmic ultrasound, Wilmer ophthalmologists and pathologists are the world leaders in diagnosing eye tumors.
Ocular melanoma treatments vary. Certain small tumors may respond to laser treatment or freezing (cryosurgery). It is possible to remove some tumors surgically and still preserve vision. A technique used by Wilmer and Radiation Oncology researchers fine-tunes radiation therapy for eye tumors to minimize the effect on healthy tissue. If the eye cancer is advanced and must be treated aggressively or removed, plastic surgeons at Wilmer perform reconstructive surgery. Often they must implant an artificial eye; "new eyes" are virtually indistinguishable from natural ones and move almost normally, although, of course, they do not see.
Researchers at the Wilmer Eye Institute at Johns Hopkins are studying hereditary patterns in childhood cancers of the eye. For the families in whom this pattern may be present, preventive measures and early detection programs instill confidence about the future. For adult eye tumors, Wilmer researchers are conducting extensive clinical trials to see which treatment methods provide the best results. Simultaneous quality-of-life trials will show which treatments patients prefer and which approaches yield the best satisfaction and function.