Purpose:
To analyze functional and anatomical outcomes following 23/25+ gauge microincisional pars plana vitrectomy surgery combined with phacoemulsification in patients developing radiation related complications and visually significant cataract after successful 125-I brachytherapy treatment for uveal malignant melanoma.
Methods:
An IRB approved retrospective, consecutive case series of 176 eyes of patients with history of uveal malignant melanoma previously treated with 125-I brachytherapy that underwent combined microincisional vitrectomy and phacoemulsification (MIVS/phaco) within the Ocular Oncology Service at the Bascom Palmer Eye Institute. All patients had visually significant cataract with radiation related complications including vasculopathy, optic neuropathy and/or exudative retinal detachment. Pre-operative evaluation included comprehensive ophthalmologic examination, sdOCT, fundus photography, and a- and b-scan ultrasound. A standard three port pars plana surgical procedure employed oblique trocar insertion, pars plana vitrectomy, removal of the posterior hyaloid with/without ERM/ILM peeling, direct endolaser tumor ablation and 4mg intravitreal triamcilonone acetonide injection (IVTA). All cases were evaluated for surgical complications and local tumor control. Extended followup included Snellen VA, IOP evaluation, quantitative echography and fundus imaging with OCT/widefield photography.
Results:
View image. All patients had surgical indications including significant cataract with radiation associated retinal complications. Patients were alive and well.
Conclusions:
Combined MIVS/phaco was effective in improving visual function and anatomy in patients with treated uveal malignant melanoma radiation related complications and visually significant cataract. Tumors decreased in size and there was no recurrence or tumor dissemination. Direct endolaser tumor ablation and IVTA may reduce rates of ongoing radiation related complications. This combined procedure addresses the modifiable causes of visual loss and has the potential to improve visual function for this complex patient series.
Keywords: tumors • retina • clinical (human) or epidemiologic studies: systems/equipment/techniques