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  • Title: Plaque radiotherapy for juxtapapillary choroidal melanoma: treatment complications and visual outcomes in 650 consecutive cases.
    Author: Sagoo MS, Shields CL, Emrich J, Mashayekhi A, Komarnicky L, Shields JA.
    Journal: JAMA Ophthalmol; 2014 Jun; 132(6):697-702. PubMed ID: 24652552.
    Abstract:
    IMPORTANCE: The treatment of juxtapapillary choroidal melanoma is challenging because of the proximity of the tumor to visually important structures. OBJECTIVE: To report the complications of treatment of juxtapapillary choroidal melanoma with plaque radiotherapy. DESIGN, SETTING, AND PARTICIPANTS: In this retrospective case series of patients from the Ocular Oncology Service, Wills Eye Hospital, 650 consecutive eyes with juxtapapillary choroidal melanoma (≤1 mm to optic disc) treated with plaque radiotherapy from October 1, 1974, through November 30, 2005, were studied. MAIN OUTCOMES AND MEASURES: Kaplan-Meier analysis of rates of radiation complications, secondary enucleation, and visual acuity outcomes. RESULTS: The 5-year (10-year) rate of nonproliferative retinopathy was 66% (75%); proliferative retinopathy, 24% (32%); maculopathy, 56% (65%); papillopathy, 61% (77%); cataract, 66% (80%); neovascular glaucoma, 15% (22%); vitreous hemorrhage, 35% (42%); and secondary enucleation, 16% (26%). Visual acuity of 20/200 or worse occurred in 54% (87%), and loss of more than 5 lines of Snellen visual acuity was found in 45% (78%). CONCLUSIONS AND RELEVANCE: Among this case series, plaque radiotherapy for juxtapapillary choroidal melanoma commonly led to retinopathy and papillopathy, but globe retention was 84% at 5 years. Vision loss should be anticipated in 45% by 5 years. Plaque radiotherapy remains a suitable choice for the treatment of juxtapapillary melanoma with a high globe retention rate.
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