DOI: https://doi.org/10.22141/2309-8147.7.2.2019.169683

Histomorphological changes in uveal melanoma after one, two, three and four daily sessions of transpupillary thermotherapy with diode laser (810 nm)

V.V. Vit, S.I. Polyakova, I.V. Tsukanova

Abstract


Background. The structural features of microscopic changes of uveal melanomas after using various conservative me­thods of treatment largely reflect the mechanisms of the therapeutic effect of one or another physical factor. The purpose was to study the histomorphological changes of uveal melanomas after one, two, three and four sessions of daily transpupillary thermotherapy (TTT). Material and methods. Histomorphological chan­ges were studied on 4 enucleated eyes with choroidal melanoma, which could not be treated conservatively. TTT sessions were held before enucleation: one patient — 1 session, one — 2 sessions daily, one — 3 sessions and one person — 4 sessions daily. TTT was performed on Quantel Medical Iridis ophthalmic retinal laser (France) in a continuous mode of irradiation using a wavelength of 810 nm with a gradual increase in power from 200 to 1,800 mW. Enucleation of the eye was carried out the day after TTT. Histomorphological objects were fixed, embedded in paraffin wax. Histological preparations were stained by hematoxylin-eosin. Studies were performed using Jenamed 2 microscope. Results. Twenty-four hours after one session of TTT, only limited areas of parenchymal swelling, diffusely distributed tumor cells with vacuole degeneration, fields of accumulated disintegrated melanoma cells, partial obliteration of small and thrombosis of large blood vessels and their necrosis, which are more pronounced with intensive pigmentation of the tumor, were found in it. After two-four sessions of TTT, the inflammatory infiltration of the tumor parenchyma is detected, especially around the affected blood vessels, as well as the inner layers of the sclera and the uveal tract. The lymphocytes and plasmatic cells were dominated in the infiltrate. The manifestations of inflammatory infiltration increase as the number of sessions of therapeutic action increases. Conclusions. Conducted histomorphological study of uveal melanoma after transpupillary thermotherapy with diode laser (810 nm) showed that in the tumor parenchyma, the ballooning degeneration, wet and dry necrosis occur, they are accompanied by destructive changes of the blood vessels walls and their thrombosis, especially in intensively pigmented tumors. Revealed histomorphological changes in tumors appear after the first session of transpupillary thermotherapy and become maximal after the fourth session that is the basis for the development of new methods of conducting transpupillary therapy — four daily sessions per one course of treatment.


Keywords


uveal melanoma; transpupillary thermotherapy; histomorphological study

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