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Alok S. Bansal, Carlos Bianciotto, Joseph Maguire, Carol Shields; Safety Of Pars Plana Vitrectomy In Eyes With Treated Posterior Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2125.
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Vitreous hemorrhage (VH) after treated choroidal melanoma can be due to proliferative radiation retinopathy, retinal vascular occlusion, tumor necrosis, retinal invasion, posterior vitreous detachment, or a retinal break or retinal detachment. If severe, VH can cause a significant reduction in visual acuity and can be treated with pars plana vitrectomy (PPV). There have been concerns regarding potential intraocular or extraocular tumor dissemination with vitreous surgery. The purpose of this study is to determine the rates of systemic metastasis, local tumor recurrence, and enucleation in eyes with treated posterior uveal melanoma undergoing PPV for VH.
Single-center, retrospective review of cases of posterior uveal melanoma treated with plaque radiotherapy that subsequently underwent PPV for VH. Baseline patient information included patient age, tumor thickness, interval between tumor treatment and VH, and interval between VH and PPV. Main outcomes evaluated were systemic metastasis, local tumor recurrence, and enucleation at last follow up.
45 eyes underwent PPV for VH after plaque radiotherapy for posterior uveal melanoma. At baseline, mean patient age was 58 years old (21 - 81 years), mean tumor thickness 4.9 mm (1.5 - 10.5 mm), mean interval between plaque therapy and VH was 21 months (1 - 81 mos.), and mean interval between VH and PPV was 17 months (0 - 126 mos.). The mean follow-up after PPV was 43 months (5 - 130 mos.). 3 of 45 eyes (7%) developed systemic metastasis with a mean time from PPV to metastasis of 37 months (5 - 71 mos.). In these 3 eyes, the mean time from plaque treatment to metastasis was 60 months (36 - 95 mos). No eyes developed local tumor recurrence after PPV. 5 of 45 eyes (11%) were enucleated with a mean time from PPV to enucleation of 9 months (3 - 21 mos.).
Based on previous studies, systemic metastasis from uveal melanoma occurs in 8% and 15% of patients at 3 and 5 years, respectively. The current results suggest that pars plana vitrectomy in eyes with treated posterior uveal melanoma does not increase the risk of metastasis. Additionally, there were no cases of local tumor recurrence.
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