Intraocular melanoma, a disease in which cancer cells form in the tissues of the eye, is estimated to affect 1,900 men and 1,590 women in the U.S. in 2023, according to the American Cancer Society. While this may appear low compared to other types of cancer, it is essential to be diagnosed and treated early because it can lead to vision loss, changes in eye shape or color, and the spread of cancer cells to other areas of the body, especially the liver.
If the eye tumor is not causing symptoms, vision change, or loss, treatment may not be immediately needed. Your healthcare provider may suggest “watchful waiting” and monitor your tumor growth before recommending a treatment. The treatment plan will depend on the specific location of the tumor, the size of the tumor, your age and health status, and whether the cancer has spread to other areas of the body.
The most common standard treatment for intraocular melanoma is surgery. This procedure can be done through the following:
- Resection – removal of the tumor and a small amount of tissues surrounding it
- Enucleation – removal of the eye and part of the optic nerve if the tumor is too large and the vision cannot be saved anymore
- Exenteration – removal of the eye and eyelids, as well as the muscles, nerves, and fat in the eye socket
Before undergoing intraocular melanoma surgery, there is some information you need to know and preparatory steps to do.
Tests to check if you are fit for intraocular melanoma surgery
To allow your healthcare provider to know your fitness for an anesthetic in case it’s needed and your capacity to make a good recovery after surgery, the following tests may be conducted:
- Blood tests to know your general health and how well your kidneys are working
- An echocardiogram to check your heart’s health
- A swab test to rule out some infections
- Lung function tests or breathing tests
- A chest X-ray
- Cardiopulmonary exercise tests
- Another eye examination using an ophthalmoscope
A pre-assessment appointment at the hospital is also necessary before the surgery so you can prepare for the operation. The more knowledge you have about what is going to happen, the less frightening it should be. Depending on the hospital, you might meet the eye surgeon, the anesthetist, and the nurses. In some hospitals, you might only meet the pre-assessment nurses.
Their individual roles include the following:
- The eye surgeon will tell you about the specific operation you will have, the benefits of having the surgery, its possible risks, and what to expect following the surgery.
- The anesthetist is the one administering the anesthesia during the surgery and making sure you are fit to receive one. You will most likely be asked if you or your family members have had anesthesia problems in the past, so they can help you prevent problems like nausea, vomiting, and being overly sleepy after receiving anesthesia.
- The nurse checks your general health by taking your weight, blood pressure, pulse, and temperature.
If you have specific questions or concerns to ask them, let them know before your appointment so that someone will be available to answer them. It sometimes helps to write down these questions and take them with you during the appointment.
Other things to do and avoid before surgery
If you smoke, your surgeon may ask you to stop as soon as possible before the procedure. American Association of Anesthesiologists explains that not doing so may cause breathing problems during or after surgery and pose a greater risk of developing pneumonia. Additionally, tobacco products constrict blood vessels and reduce oxygen supply to body tissues, slowing down healing and causing infection in the surgical incision.
Experts advise taking a break from booze at least 24 hours before surgery to minimize your risk of possible complications. According to results published in the Annals of Surgery referenced by Reuters, heavy drinkers were 73% more likely to contract a post-operation infection, 80% more likely to experience breathing difficulty, and 29% more likely to be admitted to the intensive care unit than non-drinkers. Furthermore, surgeons explain that drinking alcohol before getting anesthesia interferes with normal anesthetic drug metabolism.
If you are overweight or obese, your healthcare team may ask you to improve your diet, lose weight, or actively exercise. Having more fat tissues than normal reduces blood flow, so you are at greater risk of slower healing and surgical site infection.
In terms of food and beverage restrictions, no solid foods, especially greasy and spicy dishes, are allowed 6 hours before admission time. Drinking non-carbonated liquids like water and sports drinks are recommended up to 2 hours before surgery check-in. Caffeinated drinks like coffee and tea are not allowed.
It is important to fully inform your healthcare team regarding the medications you’re taking before undergoing surgery, including prescriptions, supplements, herbs, and drugs. Most diabetes medications, for example, may be adjusted since you will need to fast before surgery. On the other hand, anti-inflammatory and blood-thinning drugs are often stopped because they can increase the risk of bleeding during surgery.
The feeling of being frightened about having eye surgery is normal. You may worry about what your eyesight will be like after the operation, but your surgeon is supposed to discuss what you can expect after. If you are undergoing complete eye removal, it is going to affect your quality of life, but there are numerous ways to cope. Your eye surgeon may even offer to perform artificial eye replacement during the surgery.
Also, you will be asleep during the operation, so you are not supposed to feel anything. Having the right knowledge about how to prepare for intraocular melanoma surgery can help you become confident and emotionally prepared regarding your operation.