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Tara A McCannel, Mitchell Kamrava, D Jeffrey Demanes, James Lamb, John Bartlett, Robert Almanzor, Melissa Chun, Colin A McCannel; Iodine-125 Brachytherapy for Large Choroidal Melanomas: Effect of Vitrectomy and Silicone Oil on Visual Acuity. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3449.
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To describe our experience with globe-conserving therapy of large choroidal melanomas with iodine-125 brachytherapy and to compare visual outcomes and complications between patients who underwent brachytherapy alone to those who underwent brachytherapy with vitrectomy and silicone oil for radiation attenuation. We have previously reported the clinical benefit of silicone oil 1000 cs in reducing radiation retinopathy in patients.
Patients diagnosed with a choroidal melanoma and for whom a 23 mm diameter iodine-125 plaque was constructed were identified and retrospectively reviewed. Patients were included who had undergone primary treatment and who had a minimum follow-up of one year. Patient demographics and tumor characteristics were recorded at baseline and at last follow-up visit. Outcomes including tumor control, complications and metastasis were obtained.
Thirty-six patients with large choroidal melanoma were treated with a 23 mm custom-designed iodine-125 plaque with an average follow-up of 27.7 months (range 12.3 to 71 months). The average tumor height was 7.43 mm (range 2.0 to 10.95 mm) and average greatest basal diameter was 16.73 mm (range 11.72 to 21.3 mm). Twenty-two were treated with brachytherapy alone, and 14 were treated with brachytherapy in combination with vitrectomy and silicone oil. Thirty-five of 36 eyes (97%) achieved local tumor control at last follow-up. Local treatment failure occurred in two cases (5.6%), with tumor control achieved following repeat brachytherapy in one case, and enucleation for tumor control in the second. There was no case of neovascular glaucoma. Patients achieved 20/40 or better vision in 10% of the plaque group and in 40% of the plaque combined with vitrectomy and silicone oil group (p<0.05). Patients had 20/200 or worse vision in 80% of the plaque group and in 30% of the plaque/Silicone Oil group (p<0.05).
In our experience, iodine-125 brachytherapy for large choroidal melanomas is effective at achieving local tumor control with few complications. Furthermore, combining brachytherapy with vitrectomy and silicone oil significantly improves vision over plaque alone. Brachytherapy with vitrectomy and silicone oil may be indicated for globe preservation and maximizing final vision in the treatment of large choroidal melanoma.
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