Abstract
Purpose: :
To evaluate the efficacy of intravitreal bevacizumab injections for the treatment of radiation retinopathy secondary to Iodine-125 plaque brachytherapy for posterior uveal malignant melanoma.
Methods: :
All patients with posterior uveal malignant melanoma treated with Iodine-125 brachytherapy who developed or were already diagnosed with radiation retinopathy between June, 2005 and May, 2007 were enrolled in the study. Patients received intravitreal injections of bevacizumab at 6-week intervals with the need for repeat injection determined by fundus photography findings or optical coherence tomography (OCT) criteria. All patients were treated with a planned therapeutic strategy, and managed upon presentation by the same clinician. Clinical outcome variables included: visual acuity, intraocular pressure, change in degree of macular edema by OCT, change in retinal findings associated with radiation retinopathy (e.g. hemorrhage, exudate, cotton wool spots), and change in tumor size as measured by ultrasound.
Results: :
83 eyes of 82 patients were treated. There were 45 females and 37 males. Many of the patients had medical co-morbidities including diabetes (17%), hypertension (55%), and hypercholesterolemia (67%). The mean distance of the tumor to the optic nerve and fovea were 4.6 mm and 4.1 mm, respectively. The mean number of bevacizumab injections per patient was 2.7 (SD +/- 1.1) over 6 months. The median initial visual acuity was 20/70. Vision remained stable through 6 months of follow-up with a median visual acuity at month 3 of 20/80 (p=0.38) and of 20/200 at month 6 (p=0.29). The mean initial central thickness by OCT was 292 (136) which improved significantly in all patients at 3 months post-injection (p=0.05). Logistic regression revealed that significant sustained visual improvement at 6 months was associated with more severe macular edema at presentation. Intraocular pressure remained stable at 3 and 6 months of follow-up. The mean change in tumor apical height was a decrease in 0.1 mm over 6 months and a decrease in basal dimensions of 8 mm2. There was a statistically significant decrease in the total number of fundus findings associated with radiation retinopathy from the pre-treatment examination to the 3-month and the 6-month follow-up visits (p=0.011).
Conclusions: :
Bevacizumab reduces vision loss and improves macular edema secondary to radiation retinopathy induced by plaque brachytherapy for uveal melanoma. The treatment appears to be particularly effective in patients with severe macular edema at presentation.
Keywords: melanoma • oncology • tumors