Role of Vitreoretinal Surgery in Maximizing Treatment Outcome Following Complications After Proton Therapy for Uveal Melanoma

Tran, Bao Khanh; Schalenbourg, Ann; Bovey, Etienne H.; Zografos, Léonidas; Wolfensberger, Thomas J.

doi:10.1097/iae.0b013e318295f758

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…In our series, we had 1 case of early detachment (0.9%) following PBT, a round hole away from the tumour site, with a similarly low rate of 2 from 1005 eyes (0.2%) reported by Tran et al 7 Of those in the Tran series, one was a rhegmatogenous detachment, and the other a serous detachment associated with vitreous haemorrhage. The timing of vitrectomy was not specified.…”

Section: Discussionmentioning

confidence: 84%

“…6,7,11 In these cases, the extent of vitreoretinal adhesions seems to be critical, and as these adhesions tend to progress over time early retinal detachment repair is theoretically preferable and may be associated with better visual outcomes. 5,7,11 In addition to retinal detachments due to vitreoretinal traction, other mechanisms such as proliferative vitreoretinopathy, 5 poor adhesion between the retina and sclera at the site of surgical coloboma, 5 and edge recurrence are described. 15 A single case of intraocular dissemination of melanoma cells had been reported by Foster et al 10 54 months following vitrectomy in an irradiated uveal melanoma.…”

Section: Discussionmentioning

confidence: 99%

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

Chia

Smith

Hammer

et al. 2015

Eye

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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

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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

Chia

Smith

Hammer

et al. 2015

Eye

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“…Furthermore, it is known that laser photocoagulation helps to prevent neovascular glaucoma [21]. In their study, Missotten et al [22 ]found significantly elevated aqueous VEGF levels in eyes with uveal melanoma irrespective of the treatment compared with controls and eyes with a retinal detachment alone.…”

Section: Discussionmentioning

confidence: 98%

“…Vitrectomy after proton beam therapy is a safe procedure, and vitrectomy facilitates tumor surveillance through reestablishing transparency of the visual axis. Furthermore, vitrectomy increases the chances of eye retention as it allows both panretinal photocoagulation to avoid neovascular glaucoma and surgical repair of a rhegmatogenous detachment [21]. Therefore, even when functional outcome is limited, performing vitrectomy is justified.…”

Section: Discussionmentioning

confidence: 99%

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

et al. 2014

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Background: Choroidal melanoma is frequently accompanied by an exudative retinal detachment that can persist after proton beam therapy. This study investigates whether vitrectomy without tumor resection improves the clinical outcome. Methods: This is a retrospective interventional case series. Twenty patients with choroidal melanoma with exudative retinal detachment involving the macula were treated by vitrectomy, endodrainage, photocoagulation, and silicone oil tamponade after proton beam therapy. Results: The mean follow-up was 38.4 months (median 21.5, range 12.0-122.0). The mean time between proton beam therapy and surgery was 4.5 months (range 0.1-9.2). Reattachment was achieved in 95% of the patients after one vitrectomy. One patient was lost to follow-up because enucleation was performed after 45.9 months due to a secondary glaucoma. Mean visual acuity decreased from 1.1 to 1.8 logMAR before vitrectomy and after 4 years, respectively. No patient showed local tumor recurrence. Metastatic disease was present in 1 patient after 15.2 months, and this patient died after 19.2 months. Conclusion: Vitrectomy is indicated after therapeutic proton beam irradiation in patients who present with persisting exudative retinal detachment involving the macula and high local or systemic risk factors for hemorrhagic complications, thus excluding endoresection.

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“…The clinical effectiveness of proton radiotherapy (local control) can be improved by ensuring possible endoresection of the remaining part of the tumour [ 42 ]. This helps improve the outcome of treatment while at the same time preserving the eyeball.…”

Section: Discussionmentioning

confidence: 99%

Preliminary results of proton radiotherapy for choroidal melanoma – the Kraków experience

Sas-Korczyńska¹,

Markiewicz²,

Romanowska–Dixon³

et al. 2014

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Aim of the studyThe objective of the study was to present the preliminary results of proton radiotherapy as a method for treating 15 patients with choroidal melanoma.Material and methodsThe proton radiotherapy was administered using beams providing energy levels of 60 MeV, which ensures a clinical range of 28.4 mm. In addition, the beam has a very narrow penumbra of 1.3 mm and a sharp distal dose fall-off. All patients received the dose of 60 CGE (cobalt gray equivalent) given to the PTV (planning target volume). This dose was administered in 4 fractions over 4 successive days of treatment.ResultsThe tumour had regressed in 8 patients (53.3%) and remained stable in 3 patients (20%). The large tumours in another 3 patients (20%) were removed during vitrectomy (endoresection), which increased the number of patients with tumour regression up to 11 (73.3%). In the case of 1 patient, despite intraocular tumour regression occurring the choroidal melanoma had spread multifocally into the orbit, which necessitated orbit exenteration. The results ensured that the eyeballs of 14 patients (93.3%) could be saved.The follow-up period for the 15 patients ranged between 8 and 26 months (average: 17.4 months, median: 19 months). In this period some side effects were noted: an increase in intraocular pressure, retinal detachment, cataract, maculopathy, neuropathy and vitreous haemorrhaging.ConclusionsThe preliminary results confirm that proton radiotherapy is an effective method for treating patients with choroidal melanoma. This method ensures an eyeball preservation rate of 93%, with the vision function of 80% of the patients being saved.

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Role of Vitreoretinal Surgery in Maximizing Treatment Outcome Following Complications After Proton Therapy for Uveal Melanoma

Cited by 11 publications

References 15 publications

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

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

Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy

Preliminary results of proton radiotherapy for choroidal melanoma – the Kraków experience

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