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William F Mieler; Intravitreal Dexamethasone for Recalcitrant CME following Brachytherapy Treatment of Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4098.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the efficacy of intravitreal dexamethasone in the treatment of recalcitrant radiation maculopathy following Iodine-125 brachytherapy treatment of uveal melanoma.
Consecutive retrospective analysis of patients treated in a University setting between the years of 2010-13 (with minimum of 24 months follow-up).
Fifty-eight patients were diagnosed clinically and echographically with uveal melanoma with a mean base of 12.0 mm and height of 6.5 mm at the time of diagnosis. I-125 brachytherapy, with a mean dosage of 85.5 Gray, was applied over an average of 152 hours. Patients were then followed quarterly for an average of 32.1 months (range 24 – 52 months). Twenty-three patients (40%) developed radiation maculopathy an average of 17.7 months (range 12 – 31 months) post-brachytherapy, correlating with dosage of the radiation and proximity of the tumor to the macula. All patients were initially treated with intravitreal bevacizumab, often times alternating with triamcinolone. Recalcitrant CME remained seven patients, in spite of an average of 16 injections (range of 13-20 injections). These seven patients were switched to intravitreal dexamethasone (Ozurdex), with resolution of the CME after 1 to 2 injections, and stability for up to one year. Visual results were wide ranging, from 20/25 to 20/400, with five of these seven patients requiring cataract extraction.
Radiation maculopathy develops quite frequently following I-125 brachytherapy of uveal melanoma. Initial treatment with bevacizumab and/or triamcinolone is variably effective. Recalcitrant CME appears to respond quite readily to intravitreal dexamethasone (Ozurdex), and perhaps should be considered earlier in the treatment regimen of radiation-induced maculopathy.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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