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Tero Kivelä, Sebastian Eskelin, Teemu Mäkitie, Paula Summanen; Exudative Retinal Detachment from Malignant Uveal Melanoma: Predictors and Prognostic Significance. Invest. Ophthalmol. Vis. Sci. 2001;42(9):2085-2093. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
purpose. To determine independent predictors of exudative retinal detachment
(RD) in eyes with uveal melanoma and the significance of RD in
methods. The extent of exudative RD was recorded retrospectively in a
population-based cohort of 167 consecutive patients with eyes
enucleated from 1972 through 1981 because of choroidal and ciliary body
melanoma, representing all melanomas treated during that period.
Histopathologic features including microvascular loops and networks,
microvascular density (MVD), and tumor-infiltrating macrophages were
determined. Clinical and histologic predictors of RD were modeled by
multiple logistic regression with a split-sample, cross-validation
design. Survival was assessed by Kaplan-Meier analysis and adjusted for
the effect of competing predictors by Cox proportional hazards
results. Of 142 (85%) eyes with adequate data, 25% had no RD, 16% had
subretinal fluid around the tumor, 43% had clinical RD in one to two
quadrants, and 16% had RD in three to four quadrants. The RD was more
extensive if the tumor was large (P < 0.0001) and
had microvascular loops and networks (P = 0.0094)
and less extensive if it involved ciliary body (P =
0.011). High MVD (P = 0.054) and ruptured Bruch’s
membrane (P = 0.065) tended to be associated with
RD. Multiple logistic regression showed largest basal diameter (odds
ratio [OR] 1.43 for each 1-mm change, P <
0.0001), microvascular loops and networks (OR 1.95 for each category
change, P = 0.0095), and ciliary body involvement
(OR 0.20, P = 0.0039) to be independently
associated with RD; ruptured Bruch’s membrane (P =
0.96) and MVD (P = 0.87) were not associated.
Clinical RD predicted poor survival (0.59 vs. 0.37 at 20 years; P = 0.029) by Kaplan-Meier analysis, but not after
adjusting for other prognostic factors by Cox regression (hazard ratio[
HR] 1.00, P = 1.0).
conclusions. Tumor size, which may be a surrogate measure for total vascular content
and decompensation of choriocapillaris and retinal pigment epithelium,
is a strong predictor of exudative RD. Microvascular loops and networks
are likewise associated with exudative RD. Exudative RD is not
associated with survival after adjusting for tumor size and
microvascular loops and networks.
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