Transscleral resection is a sophisticated surgical procedure used primarily for treating ocular tumors. This technique involves the removal of tumors located in the eye’s uveal tract, which includes the iris, ciliary body, and choroid. The procedure is considered when less invasive treatments, such as laser therapy or radiation, are unsuitable or have proven ineffective. This article aims to provide a detailed overview of transscleral resection, its indications, procedure, benefits, risks, and post-operative care.

Transscleral resection is primarily indicated for:

1. Uveal Melanoma: This is the most common type of intraocular tumor in adults, originating from melanocytes in the uveal tract.
2. Ciliary Body Tumors: Tumors in the ciliary body can cause various complications, including secondary glaucoma and lens dislocation.
3. Choroidal Hemangiomas: These benign vascular tumors can cause visual disturbances due to fluid leakage and retinal detachment.

Transscleral resection is a meticulous and delicate surgery. The key steps involved are:

1. Preoperative Preparation: Comprehensive imaging studies, including ultrasound, fluorescein angiography, and magnetic resonance imaging (MRI), are performed to assess the tumor’s size, location, and extent.
2. Anesthesia: The procedure is typically performed under general anesthesia to ensure patient comfort and immobility.
3. Surgical Approach: The eye is positioned, and the sclera (the white outer layer of the eyeball) is carefully incised. This approach allows direct access to the uveal tract.
4. Tumor Visualization and Removal: Specialized instruments and magnification techniques are used to visualize the tumor. The tumor is then excised with precision to minimize damage to surrounding healthy tissues.
5. Scleral Closure: After the tumor is removed, the scleral incision is meticulously closed with fine sutures to maintain the eye’s structural integrity.
6. Intraocular Reconstruction: In some cases, intraocular lenses or other reconstructive measures may be necessary to restore vision.

The primary benefits of transscleral resection include:

1. Tumor Control: This procedure offers a high success rate in completely removing ocular tumors, reducing the risk of recurrence.
2. Vision Preservation: By targeting and removing only the tumor, this technique aims to preserve as much of the patient’s vision as possible.
3. Minimally Invasive Alternative: Compared to enucleation (complete removal of the eye), transscleral resection is less invasive and preserves the eyeball.

As with any surgical procedure, transscleral resection carries potential risks and complications, such as:

1. Infection: Postoperative infections can occur, necessitating prompt medical attention and treatment.
2. Hemorrhage: Intraoperative or postoperative bleeding can lead to complications, including vision loss.
3. Retinal Detachment: The risk of retinal detachment increases with the manipulation of intraocular structures during surgery.
4. Glaucoma: Changes in intraocular pressure following surgery can lead to glaucoma, requiring further management.
5. Visual Disturbances: Despite efforts to preserve vision, some patients may experience visual disturbances post-surgery, such as blurred vision or double vision.

Effective post-operative care is crucial for a successful recovery:

1. Follow-Up Appointments: Regular follow-up visits are essential to monitor healing and detect any complications early.
2. Medications: Patients may be prescribed antibiotics to prevent infection and corticosteroids to reduce inflammation.
3. Activity Restrictions: Patients are typically advised to avoid strenuous activities and heavy lifting during the initial recovery period.
4. Vision Rehabilitation: Depending on the extent of surgery and vision loss, vision rehabilitation therapies may be recommended to optimize visual function.
5. Lifestyle Adjustments: Patients may need to make lifestyle adjustments, such as wearing protective eyewear and managing lighting conditions to reduce glare and eye strain.

Transscleral resection is a valuable surgical option for treating certain intraocular tumors. While it offers significant benefits, including tumor control and vision preservation, it also carries inherent risks that must be carefully managed. Through meticulous surgical technique, comprehensive preoperative planning, and diligent postoperative care, patients can achieve favorable outcomes and maintain their quality of life. As with any medical procedure, a thorough discussion with a qualified ophthalmologist is essential to determine the best course of action tailored to the individual’s specific condition.

World Eye Care Foundation’s eyecare.live brings you the latest information from various industry sources and experts in eye health and vision care. Please consult with your eye care provider for more general information and specific eye conditions. We do not provide any medical advice, suggestions or recommendations in any health conditions.