Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. Broadly, there are two surgical resection techniques:
Transscleral resection or “exoresection”. This technique is usually employed for small tumors located in the ciliary body or iris. Irradiation is not commonly performed
"Endoresection” via a pars plana vitrectomy. This technique is performed for tumors of the posterior segment, where irradiation of the tumor will significantly affect critical structures within the eye, such as the optic nerve and macula. This technique involves the surgical resection of the ocular melanoma by using vitrectomy techniques. An incision is made in the retina to allow access to the choroidal melanoma arising from the underlying choroid. The tumor is cut into small fragments and aspirated by the vitrector. The retina is placed back in place and laser treatment is administered during the operation to "weld" the retina in place. The eye is filled with silicone oil to hold the retina in place until scarring has welded the retina in position. This operation is usually performed to remove moderately-large sized tumors after radiotherapy if they become “toxic” to the eye. In rare cases, if the endoresection is the primary treatment procedure, radiation therapy by means of plaque radiotherapy is also administered at the end of the surgery to prevent tumor recurrence.