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Yachna Ahuja, Rowan M. Thomson, Keith M. Furutani, Ryan W. Shultz, Scott L. Stafford, Sundeep Dev, Nakhleh E. Abu-Yaghi, Dale Reynolds, Jose S. Pulido; Pre-Clinical and Clinical Evaluation of Intraocular Silicone Oil Placement Prior to Iodine-125 Brachytherapy for Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):3276.
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A recent preclinical study suggests that using intraocular silicone oil prior to iodine 125 (125I) brachytherapy for uveal melanoma may reduce the development of radiation retinopathy. We report our pre-clinical and clinical cases of the use of silicone oil with 125I brachytherapy to suggest that this technique should only be used in very selected cases.
A 16 mm COMS plaque loaded with 125I seeds was simulated on an eye model containing silicone oil as a vitreous substitute using BrachyDose. The radiation dose ratio of silicone oil versus water to ocular structures was calculated at angles subtended from the center of the eye.
When silicone oil is used, the radiation dose to ocular structures at the AP axis of the eye is 65% of the dose in an eye without silicone oil. Radiation dose ratios on the retina increase from 0.45 to 0.99 when moving from points at the opposite side of the plaque to the plaque’s central axis. Between November 2009 and January 2010, three female patients (age 58-69, median 58) at our center underwent 23-gauge vitrectomy and silicone oil placement prior to 125I brachytherapy (80-85 Gy) for posteriorly located medium or large uveal melanomas. Preoperative vision ranged from 20/25 to 20/40 (median 20/30). Each patient has required silicone oil removal, in addition to developing dense nuclear sclerotic cataracts. One also developed a retinal detachment requiring scleral buckle and vitrectomy. Postsurgical follow-up period has ranged between 6-10 months (median 7 months).Vision at most recent follow-up ranged from 20/100 to 4/200 (median 20/100). To date, none of these patients have developed radiation retinopathy.
We recommend limiting the consideration of the use of silicone oil in 125I brachytherapy patients to select cases, such as posterior pole melanomas with a high risk of intraocular bleeding or retinal detachment, or as retinal tamponade after intraocular biopsy. There is no conclusive clinical data in the literature that supports the use of silicone oil to decrease the development of radiation retinopathy.
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