No-touch technique for intraocular malignant melanomas
F. T. Fraunfelder, F. W. Boozman, R. S. Wilson and A. H. Thomas
Large variations in intraocular pressure occur during enucleation, scleral
depression, 32P testing, and vigorous rubbing of an eye. Data from animal
studies show that during a critical phase of an intraocular malignant
melanoma, ocular massage significantly decreased longevity due to increased
metastastic disease. We report "no-touch" technique to prevent tumor spread
from occurring secondary to ocular manipulation during enucleation. This
technique avoids IOP elevations above 50 mm Hg before freezing completely
around the tumor, thereby preventing flow of fluid and blood to or from the
tumor prior to the manipulation necessary for enucleation. Theoretically,
the patient with an ocular tumor should be warned against vigorous rubbing
of his eyes and hard lid squeezes or diagnostic techniques that elevate
IOP. The ophthalmologist should perform enucleation with gentieness and
avoid pressure on the globe. Patients who are being followed up with a
suspected ocular tumor should be warned not to rub or vigorously squeeze
their eyelids.
