Purpose: To assess the role of vitreoretinal surgery in maximizing treatment outcome following complications after proton therapy for uveal melanoma and to evaluate its safety.
Methods: Retrospective chart study on 21 patients (2% of a total of 1,005 treated by proton therapy between January 2003 and August 2007) who had developed a complication requiring vitreoretinal surgery. Mean/median total follow-up after irradiation was 43/43 months (range, 12–70 months).
Results: Indications for surgery included vitreous hemorrhage (n = 13), epimacular membrane (n = 5), rhegmatogenous retinal detachment (n = 1), combined vitreous hemorrhage with total serous retinal detachment (n = 1), and vitritis (n = 1). Mean/median interval for vitreoretinal surgery after irradiation was 21/20 months (range, 4–45 months), and mean/median follow-up after pars plana vitrectomy was 22/23 months (range, 2–56 months). Pars plana vitrectomy was combined with retinal photocoagulation (n = 5), air/gas (n = 5), or silicone oil tamponade (n = 1). Mean Snellen visual acuity was 20/200 (0–20/40) before and 20/100 (0–20/25) after pars plana vitrectomy. A transient postoperative rise in intraocular pressure was measured in seven patients. Four patients developed phthisis bulbi.
Conclusion: Vitreoretinal surgery was efficient in maximizing treatment outcome after proton therapy, as it allowed a better oncologic follow-up. Pars plana vitrectomy permitted panretinal photocoagulation to avoid neovascular glaucoma or retinal detachment repair. Macular surgery improved visual acuity, especially in anterior melanoma, whereas repeated surgery may increase the risk of enucleation.
Vitreoretinal surgery after proton therapy for uveal melanoma is efficient in maximizing treatment outcome by permitting follow-up of the tumor scar and panretinal photocoagulation to avoid neovascular glaucoma. Macular surgery improves vision, especially if the melanoma is anterior, whereas repeated vitrectomies may increase the risk of phthisis bulbi.
Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
Reprint requests: Thomas J. Wolfensberger, MD, Jules-Gonin Eye Hospital, University of Lausanne, Avenue de France 15, Lausanne CH-1004, Switzerland; e-mail: firstname.lastname@example.org
Presented at the Club Jules-Gonin, XXVIIth Meeting, Kyoto, Japan, November 6, 2010.
B.-K. Tran and A. Schalenbourg contributed equally to this study.
None of the authors have any financial/conflicting interests to disclose.