Intraocular Tumors and Glaucoma Treatment & Management

Updated: Jun 25, 2020
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
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Treatment

Medical Care

Glaucoma management itself begins with medical therapy, concurrent with treatment of the intraocular tumor through surgery, radiation, chemotherapy, or a combination of these treatments.

Standard methods of intraocular pressure control should be used, although success rates with these topical medications will necessarily be low.

Anti-vascular endothelial growth factor (anti-VEGF) therapy may be helpful in those cases where neovascularization plays a role in the pathogenesis of the glaucoma. [7]

In systemic lymphoma, leukemia, and metastatic malignancies, treatment will often include systemic chemotherapy and radiation, with current regimens favoring the use of chemotherapy first.

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Surgical Care

Surgical options to control intraocular pressure must be tempered by the need for preventing extraocular tumor spread. For smaller tumors, observation is warranted until growth is documented. Iridectomy or iridocyclectomy also are options for removing smaller tumors. For anterior tumors, argon laser trabeculopexy to tumor-free areas is an option. More posterior tumors may require local resection, photocoagulation, or episcleral radiopaque therapy. Enucleation or exenteration also is an option.

For melanocytoma, laser or surgical excision of the lesion may decrease the pigment load and decrease the intraocular pressure.

Glaucoma usually is associated with advanced stages of retinoblastoma, and enucleation may need to be discussed. Other therapeutic options include radiotherapy, cryotherapy, and photocoagulation. Any surgical intervention must be tempered by the risk of extraocular spread. [8]

Blind eyes should not undergo incisional glaucoma surgery because of the risk of spreading the tumor to outside the globe.

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Consultations

Glaucoma specialist or oncologist

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