Incidence and indications for pars plana vitrectomy following the treatment of posterior uveal melanomas in Scotland

Abstract

Background Globe-sparing treatments such as plaque brachytherapy, local or endoresection, and proton beam therapy (PBT) are the treatments of choice for posterior uveal melanoma. However, both early and late complications can arise from these techniques, including vitreous haemorrhage (VH) and retinal detachment (RD). Choroidal melanomas in Scotland are managed by a single unit, the Scottish Ocular Oncology Service (SOOS). Methods Indications and outcomes from surgery were analysed for patients undergoing vitrectomy following treatment for uveal melanoma in the SOOS between 1998 and 2013. Results Seventeen from 715 cases (2.4%) required vitrectomy, of which 8/445 (1.8%) followed plaque brachytherapy, 7/43 (16.3%) combined local resection and brachytherapy, and 2/227 (0.9%) PBT. Casenotes were reviewed for 16/17 cases, with surgery indicated for VH in 10 (63%), RD in 5 (31%), and combined VH/RD in 1 (6%). The median interval from initial tumour treatment to vitrectomy was 5.8 months (range 10 days to 8.8 years). Ten (63%) required early vitrectomy (within 6 months), of which the majority (70%) followed combined resection/ brachytherapy. Six (37%) required late vitrectomy (after 6 months), of which all were non-clearing VH following plaque brachytherapy, with proliferative retinopathy in 4/6 (67%), and tumour recurrence in 2/6 (33%). Overall vision improved in 8 eyes (50%), remained the same in 2 (12.5%), and deteriorated in 6 (37.5%). Conclusions Early vitrectomy was most commonly indicated for RD following local resection, and late vitrectomy for VH due to radiation retinopathy. The majority of

Treatment-Related Complications and Functional Results after Ruthenium-106 Brachytherapy in Small to Medium Size Uveal Melanomas (Part 2)

“…Other, less common complications, described in the literature include postoperative retinal detachment, vitreous hemorrhage, and scleral necrosis. In our study, the incidence of vitreous hemorrhage was 11.8%, the occurrence (or persistence) of retinal detachment after treatment was 13%, and that of scleral necrosis was 2.1%.In the literature, the occurrence of vitreous hemorrhage and retinal detachment ranges between 15% and 26% and between 1% and 2.5%, respectively [14,[18][19][20][21]. The higher rates of retinal detachment in our study can be explained by the inclusion of both exudative and rhegmatogenous form.…”

Prevention and treatment of the toxic tumour syndrome following primary proton beam therapy of choroidal melanomas

“…Thus, based on the literature, it appears that removal of a choroidal melanoma may spare the eye some severe complications of radiation such as retinopathy and optic neuropathy and that these benefits may occur even when the tumour is treated with plaque brachytherapy or proton beam irradiation [25]. Endoresection can be performed irrespective of tumour dimensions, but there is an increased risk of local complications when the base exceeds 15 mm [5,12,16,21,23,24]. Biewald et al performed the endoresection in tumours with a base diameter up to 20 mm and the most common observed complications were: phthisis, local recurrence, opaque media with loss of fundus visibility and severe vitreous haemorrhage [27].…”

“…To our knowledge, there are a few publications concerning the endoresection as a prevention of TTS following the choroidal melanoma irradiation [8,9]. Most reports present the results of endoresection in eyes with established TTS or analyse the results of endoresection as a primary method of treatment with or without adjuvant brachytherapy [5,9,[12][13][14][15][16][17][18][19][20].…”

Complications and adverse events of plaque brachytherapy for ocular melanoma

“…As ischemia and neovascularization increase, the risk of vitreous hemorrhage and retinal detachment also increase. In the ocular melanoma population, the incidence of vitreous hemorrhage ranges from 4.1% at one year to 15.1% at five years to 18.6% at ten years, whereas retinal detachment occurs in 1-2% of patients following 125 I plaque brachytherapy [42,43]. Risk factors for vitreous hemorrhage include pre-existing diabetic retinopathy, shorter tumor distance to the optic disc, greater initial tumor thickness, and break in the Bruch’s membrane [44].…”