{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:50:46Z","timestamp":1790013046160,"version":"4.0.1"},"reference-count":35,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T00:00:00Z","timestamp":1631836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.<\/jats:p>","DOI":"10.3390\/ijms221810066","type":"journal-article","created":{"date-parts":[[2021,9,17]],"date-time":"2021-09-17T21:23:29Z","timestamp":1631913809000},"page":"10066","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Vitreoretinal Surgery in the Prevention and Treatment of Toxic Tumour Syndrome in Uveal Melanoma: A Systematic Review"],"prefix":"10.3390","volume":"22","author":[{"given":"Mario R.","family":"Romano","sequence":"first","affiliation":[{"name":"Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiammetta","family":"Catania","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4079-8881","authenticated-orcid":false,"given":"Filippo","family":"Confalonieri","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5892-7533","authenticated-orcid":false,"given":"Piero","family":"Zollet","sequence":"additional","affiliation":[{"name":"Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090 Milan, Italy"},{"name":"Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Allegrini","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Sergenti","sequence":"additional","affiliation":[{"name":"Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4344-1001","authenticated-orcid":false,"given":"Francesco B.","family":"Lanza","sequence":"additional","affiliation":[{"name":"Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariantonia","family":"Ferrara","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Humanitas Castelli, Via Mazzini 11, 24128 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2703-2056","authenticated-orcid":false,"given":"Martina","family":"Angi","sequence":"additional","affiliation":[{"name":"Ocular Oncology Service, Department of Surgical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1157","DOI":"10.1038\/eye.2012.126","article-title":"Progress in the management of patients with uveal melanoma. 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