Safety of Pars Plana Vitrectomy in Eyes With Plaque-Irradiated Posterior Uveal Melanoma

Bansal, Alok; Bianciotto, Carlos; Maguire, Joseph I.; Regillo, Carl D.; Shields, Jerry A.; Shields, Carol L.

doi:10.1001/archophthalmol.2012.2391

Cited by 28 publications

(16 citation statements)

References 25 publications

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“…This is consistent with previously published rates of 1.2% (47 from 3841 eyes) reported by Bansal et al 8 and 2.0% (74 of 3707 eyes) by Bianciotto et al, 9 both following application of Iodine-125 plaques. In keeping with our findings, existing literature recognises that vitrectomy for vitreous haemorrhage following plaque brachytherapy is usually a late phenomenon 8,10 and commonly associated with radiation retinopathy. 9 We had no cases of vitrectomy for vitreous haemorrhage following primary PBT, although Tran et al 7 report a rate of 2.0% after an average of 21 months, and with vitreous haemorrhage more common with more posteriorly located tumours.…”

Section: Discussionsupporting

confidence: 91%

“…Two studies report successful vitrectomy for clearance of vitreous haemorrhage following Iodine-125 brachytherapy at rates of 53/74 (72%) 9 and 35/47 (74%), 8 but the visual outcomes were poor with 34/47 (72%) 8 of eyes achieving an acuity of 6/60 or worse, attributed to radiation retinopathy. In contrast, our rate of complete clearance of vitreous haemorrhage was lower at 2/6 (33%) but with similar final visual acuity of 6/60 or worse in 4/6 (67%).…”

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: Discussionsupporting

confidence: 91%

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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“…A subsequent report from our data has shown that vitrectomy is safe and effective for eyes with melanoma and vitreous hemorrhage after radiotherapy. 2 Based on their experience with ruthenium plaque radiotherapy for uveal melanoma, Avanish et al have posed a few additional queries. They question the etiology of vitreous hemorrhage in their case of small melanoma that occurred 1 week after transretinal tumor biopsy with vitreous cutter.…”

Section: Replymentioning

confidence: 99%

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Shields¹,

Bianciotto²,

Shields³

2013

Retina

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“…More recently, Bansal et al reported on the author's experience with vitrectomy for vitreous hemorrhage in eyes with posterior choroidal melanoma. [25] They reviewed the medical records of 47 patients who underwent vitrectomy for vitreous hemorrhage following Iodine-125 brachytherapy for posterior choroidal melanoma. The primary outcome of their analysis included rates of intraocular tumor dissemination, extrascleral extension, local tumor recurrence, and systemic metastasis.…”

Section: Pars Plana Vitrectomy For Complications After Brachytherapy mentioning

confidence: 99%

“…In summary, the reports by Foster et al, [24] Bansal et al, [25] and Mason and Mullins [15] reveal the safety of performing vitrectomy in patients who have been treated with brachytherapy for choroidal melanoma. The combined reports by Foster and Mason found zero of 29 patients developed metastatic disease following vitrectomy, while Bansal found only four of 47 patients to have developed metastatic disease following vitrectomy in patients with treated choroidal melanoma.…”

Section: Pars Plana Vitrectomy For Complications After Brachytherapy mentioning

confidence: 99%

Pars Plana Vitrectomy Associated with or Following Plaque Brachytherapy for Choroidal Melanoma

Mason¹,

Mullins²

2013

Melanoma - From Early Detection to Treatment

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quirement of sclerotomy sutures, postoperative astigmatism, and patient discomfort. Recently, small gauge PPV has been introduced. The -gauge transconjunctival sutureless PPV system enables sutureless three-port PPV without the need for conjunctival peritomies, decreases mean operative times, reduces post surgical patient discomfort, and decreases surgically-induced trauma at sclerotomy sites. [ ] Decreased traumatic conjunctival and scleral manipulation with less postop inflammation, as well as less induced astigmatism, allows for more rapid postoperative visual recovery. The self-sealing nature of the incisions in sutureless PPV, however, does pose potential concerns for the possibility of vitreous incarceration, postoperative endophthalmitis, and hypotony. [ -] Posterior uveal melanomas can cause visual disturbances secondary to vitreous hemorrhage, exudative retinal detachments, and radiation-related complications. Treatment consisted of enucleation prior to the Collaborative Ocular Melanoma Study COMS , which found that at twelve years, there were no significant differences in survival between enucleation and plaque brachytherapy with regards to medium size choroidal melanomas. [ ] Radiation has resulted in a new set of complications, some of which are amenable to the use of vitrectomy surgery in the setting of a treated choroidal melanoma. This chapter will discuss the safety and efficacy of vitrectomy regarding diagnosis and biopsy, endoresection, and radiation-induced complications.

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Safety of Pars Plana Vitrectomy in Eyes With Plaque-Irradiated Posterior Uveal Melanoma

Abstract: Management of vitreous hemorrhage by PPV in eyes with previously irradiated uveal melanoma appears to be safe and without increased risk for intraocular, local, orbital, or systemic dissemination of the tumor.

Cited by 28 publications

References 25 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

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Pars Plana Vitrectomy Associated with or Following Plaque Brachytherapy for Choroidal Melanoma

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