The failure of this combined treatment may be looked on as a reason to discontinue the use of cryotherapy as an adjunctive treatment. However, the known effectiveness of primary cryotherapy in the treatment of some small melanocytic tumors4and the effective management of an edge recurrence with cryotherapy after an initial treatment with TTT as in an unreported case, as well as the potential value in preventing extrascleral extensions, argue for continuing to explore the use of cryotherapy as an adjunctive treatment in selected cases of small melanomas. Of the 2 tumors that developed recurrences after the use of combined therapy with TTT and cryopexy, effective management appears to have been accomplished with additional TTT in 1 tumor. Brachytherapy was used to treat the other tumor recurrence. This was followed by local control of the tumor for several years, but the treatments failed to prevent metastases. Although meaningful survival statistics cannot be drawn from this small series, the development of metastatic melanoma in 1 of the 2 patients with tumor recurrence serves to remind us that a trend toward reduced survival has been demonstrated following local tumor failure after brachytherapy.6It remains a goal to eliminate tumor recurrences. One eye developed an epiretinal membrane with resulting visual impairment despite successful pars plana vitrectomy and membrane peeling. Although epiretinal membrane formation can be seen after TTT alone, cryopexy has also been shown to produce epiretinal membrane, especially when used with heavy applications as in this case series.7It remains uncertain whether the epiretinal membrane in this series was induced from TTT, cryotherapy, or both.