PREOPERATIVE DIAGNOSIS:
Choroidal melanoma, left eye.
POSTOPERATIVE DIAGNOSIS:
Choroidal melanoma, left eye.
PROCEDURES PERFORMED:
1. Removal of radioactive iodine-125 plaque, left eye.
2. Tumor laser treatment, left eye.
SURGEON: John Doe, MD
ANESTHESIA: Local/MAC.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and was positioned on the operating table. Cardiac and blood pressure monitoring devices were applied. Intravenous sedatives were administered and a retrobulbar and supratrochlear injection of Carbocaine 2% plain was administered without complications. The patient was prepped and draped in the usual fashion for a procedure of the left eye.
A lid speculum was inserted between the lids of the left eye to expose the eye. The conjunctival sutures from the recent prior procedure were cut and removed. The conjunctiva was reflected into the superotemporal quadrant to reveal the plaque fixation sutures and radioactive plaque. The three plaque fixation sutures were cut and removed. The plaque was then slid away from its apposition to the sclera and transferred off the table to the lead carrier. The conjunctiva was closed with interrupted sutures of 7-0 Vicryl. The laser treatment was then performed using the argon green indirect ophthalmoscope laser with 20 diopter lens. The spot size on the retina was adjusted to between 0.25 and 0.5 mm on the retina during the treatment. The power setting was 300 milliwatts on continuous duration exposure. The end point of treatment was dull white discoloration of the entire juxtapapillary portion of the choroidal tumor. The total treatment time was approximately 12 minutes.
Following completion of the laser therapy, the lid speculum was removed. Bacitracin, polymyxin ointment was applied to the surface of the eye. The lids were patched with a sterile eye patch. The patient tolerated the procedure well and was transferred to same day surgery in satisfactory condition for postoperative care.
