[Kinetics of indocyanine green (ICG) and clinical use for enhancement of transpupillary thermotherapy (TTT) in hypopigmented small choroidal melanomas].

BACKGROUND: To determine the efficacy of intravenous indocyanine green (ICG) as an adjuvant to TTT for hypopigmented choroidal melanomas.

PATIENTS AND METHODS: ICG kinetics in melanoma tissue were evaluated by taking standardized ICG angiograms in 28 eyes with small choroidal melanomas. In a prospective non-randomized analysis 12 eyes with hypopigmented choroidal melanomas (posterior to the equator with thickness
RESULTS: Pharmacokinetic analyses revealed the onset of fluorescence after 42 seconds (mean) in pigmented versus 22 seconds in amelanotic tumors. Persistence of maximum fluorescence was found for 20 minutes (mean) irrespective of the grade of pigmentation. Six eyes revealed tumor regression within 2 - 4 months after one treatment session. Three eyes flattened after two sessions within 6 - 8 months. Three eyes were judged as failures (two required ruthenium-106 radiotherapy because of insufficient regression after two sessions of TTT and one eye was enucleated because of regrowth after radiotherapy and TTT). Visual acuity was unchanged or improved in 7 eyes. Ocular side effects were epiretinal gliosis (2), macular edema (1) and temporary retrobulbar pain (3).

CONCLUSIONS: TTT with adjuvant ICG was successful in 9 out of 12 hypopigmented tumors. Further research with a larger sample of patients in a prospective and randomized analysis and longer follow-up are mandatory to determine the role of ICG in TTT.