Transpupillary thermotherapy for choroidal melanomas: A systematic review and meta-analysis.

Objective: This systematic review meta-analysis evaluates the efficacy and safety of transpupillary thermotherapy (TTT) for the management of choroidal melanaomas. Study Design: Systematic review and meta-analysis. Setting: Review of published international literature on transpupillary thermotherapy (TTT) for choroidal melanomas. Period: All available studies from database inception to January 2025. Methods: This study was registered in PROSPERO (ID: CRD420251141671). A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. Inclusion criteria were treatment-naïve small choroidal melanomas (<4.5 mm thickness, <12 mm basal diameter) treated with TTT and reporting at least one of the outcomes: tumor control, globe salvage, adverse effects, or metastasis. Studies with >12 patients and ≥12 months follow-up were included. Data were extracted independently by two reviewers, and risk of bias was assessed using RoB 2 and JBI tools. Pooled estimates were calculated using a random-effects model. Results: Eighteen studies comprising 1,296 eyes were included. Tumor thickness ranged from 0.78 mm to 4.5 mm, with a base diameter <12 mm, representing data on small-sized choroidal melanomas. Meta-analysis demonstrated a pooled tumor control rate of 0.81 (95% CI: 0.73-0.88). Globe salvage rate was 0.94 (95% CI: 0.91-0.96). The pooled adverse effects rate was 0.37 (95% CI: 0.22-0.54), while metastasis rate was 0.04 (95% CI: 0.02–0.06). Notable adverse effects included macular edema, epiretinal membrane, optic disc atrophy, retinal vein occlusion, vitreous hemorrhage, and serous retinal detachment. Conclusion: Transpupillary thermotherapy appears to be an effective treatment option for small-sized choroidal melanomas, with generally favorable tumor control and globe salvage outcomes. Adverse effects are more frequently reported in tumors involving the macula or peripapillary region. Overall, TTT provides outcomes comparable, to other treatment modalities.