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Crystal Hung, Tara McCannel, Simon Law, JoAnn Giaconi; Glaucoma in Patients After Iodine-125 Brachytherapy for Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3523.
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Patients with uveal melanoma may have exacerbation of preexisting glaucoma or develop secondary glaucoma after brachytherapy. The characteristics of glaucoma in treated uveal melanoma remain poorly understood. We describe the incidence, subtype, and outcomes of glaucoma in patients with I-125 plaque brachytherapy for uveal melanoma.
Records of all patients who underwent brachytherapy for uveal melanoma between 2005 and 2011 by a single surgeon (TAM) were retrospectively reviewed. Patients with glaucoma or glaucoma suspect (GS, defined by intraocular pressure requiring treatment), were included. The incidence, subtype, and IOP control were described statistically.
A total of 341 patients were diagnosed with uveal melanoma and underwent I-125 brachytherapy; 44 (12.9%) had a diagnosis of glaucoma. The melanoma involved the iris (5), ciliary body (3), ciliochoroid (2), and choroid (34). Mean follow-up after brachytherapy was 36.5±20.4 months (range: 5-76 months). Of the 44 patients, 12 (3.5%) had preexisting diagnoses of glaucoma (9) or GS (3); 33 (9.7%, including 2 preexisting GS) developed glaucoma following brachytherapy; 1 (0.2%) became GS. Glaucoma diagnoses were neovascular (NVG, 19), open angle (4), angle closure (1), angle recession (1), melanomacytic (1), combined (1), phacolytic (1), pigmentary (1), and non-specific (15). In the 44 patients, the mean pre-brachytherapy IOP was 15.7±4.0mmHg. The mean maximum post-brachytherapy was 33.4±13.8mmHg. Eight (18.2%) patients experienced post-operative day 1 IOP spikes (32±14.0mmHg). The time from brachytherapy to highest IOP averaged 18.2±16.7 months. The mean final IOP was 17.2±6.7mmHg. 38 patients (86.4%) were managed medically, 5 (11.4%) underwent tube-shunt surgery, and 1 (2.3%) was enucleated. Of note, 9 of the 19 NVG cases were treated with anti-VEGF; none were enucleated. At last follow-up, 5 patients (11.4%) had uveal melanoma metastasis; 3 expired as a result of metastasis. None of the 5 patients who underwent tube-shunt surgery have developed metastasis to date.
We report a 12.9% incidence of glaucoma after I-125 plaque brachytherapy. The IOP in most patients can be controlled with medical therapy. Anti-VEGF therapy may be an important adjunctive therapy in NVG. When maximal medical therapy fails to control IOP, glaucoma tube-shunt surgery may be an option for optimal IOP control.
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