June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
Clinical course of radiation-induced choroidal tumor vasculopathy with progressive exudative retinal detachment following plaque radiotherapy for primary posterior uveal melanoma
Author Affiliations & Notes
  • James J Augsburger
    Ophthalmology, University of Cincinnati, Cincinnati, Ohio, United States
  • Cassandra C Skinner
    Ophthalmology, University of Cincinnati, Cincinnati, Ohio, United States
  • Zelia M Correa
    Ophthalmology, University of Cincinnati, Cincinnati, Ohio, United States
  • Footnotes
    Commercial Relationships   James Augsburger, None; Cassandra Skinner, None; Zelia Correa, Castle BioSciences (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 2499. doi:
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      James J Augsburger, Cassandra C Skinner, Zelia M Correa; Clinical course of radiation-induced choroidal tumor vasculopathy with progressive exudative retinal detachment following plaque radiotherapy for primary posterior uveal melanoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2499.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Occasional patients with primary posterior uveal melanoma treated by plaque radiotherapy develop radiation-induced “tumor vasculopathy” characterized by development of a progressive exudative retinal detachment surrounding the irradiated tumor residue. During the past several years, such eyes have frequently been treated by intravitreal anti-VEGF drugs, and favorable responses to such therapy have been reported in some of these patients. The purpose of this study was to determine the clinical course of such eyes that were encountered prior to the advent of intra-vitreal anti-VEGF drug therapy.

Methods : Retrospective chart review of all patients treated by plaque radiotherapy for a posterior uveal melanoma 1980 through 2000 with identification of those patients who developed radiation-induced chorioretinopathy following a post-treatment latent interval and exhibited a progressive exudative retinal detachment surrounding the residual irradiated tumor. The clinical course of the exudative retinal detachment, the visual status of the eye over time, and ultimate outcome of the eye in these patients were evaluated.

Results : The study group consisted of 34 patients (21 men, 13 women). The mean largest basal diameter (12.1 mm) and mean maximal tumor thickness (6.7 mm) were not substantially different than those dimensions in our total at-risk population of 1477 cases. The tumor was exclusively choroidal in 88.2% and involved the ciliary body in 38.2%. All 34 eyes became legally blind within a median post-treatment interval of 25 months, and 21 of the eyes (61.8%) ultimately became NLP. Most of these eyes developed neovascular glaucoma and recurrent intraocular bleeding from the surface of the tumor. Seven of these eyes were ultimately enucleated. The 6-yr cumulative actuarial probability of secondary enucleation was 0.2. Illustrative cases will be presented.

Conclusions : Eyes that experience radiation-induced “tumor vasculopathy” with progressive exudative retinal detachment after plaque radiotherapy for posterior uveal melanoma appear to have a very poor prognosis for retention of useful vision in the absence of intravitreal anti-VEGF drug injections.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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