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Indications for trans-scleral local resection of uveal melanoma.

Manschot's comments on psychological wellbeing after local resection can only be speculative, because as a pathologist he could not have met many patients treated conservatively, let alone by local resection. Loss of an eye is a significant psychological trauma for most patients and recent studies indicate that quality of life after plaque radiotherapy is superior to that after enucleation, despite the need for follow up (Y Brandberg, E Kock, S Seregard, A F Trampe, Psychological consequences of choroidal melanoma, JERMOV 1995, personal communication). Our patients have selected local resection in preference to enucleation after being fully informed of all the risks and expected outcomes and are therefore highly motivated. Our impression is that very few of these patients express regret about taking this decision, even when complications occur. Nevertheless, formal quality of life studies are necessary and, indeed, are in preparation. These will take into account not only visual acuity but also the visual field, which is often more useful if the fellow eye is healthy.