Abstract
Purpose :
To evaluate the efficacy and safety of prompt intravitreal dexamethasone implant compared with observation in the management of extensive exudative retinal detachment (RD) secondary to posterior uveal melanoma.
Methods :
Forty-two patients affected by posterior uveal melanoma and treated by I-125 brachytherapy with extensive exudative RD (>10 mm in largest basal diameter) were included. Patients received intravitreal dexamethasone implant at plaque removal choosing the injection site in quadrants not involved by tumor or RD. Forty-two patients served as controls (observation group). Patients underwent follow-up examinations every 2 months in the first 6 months and every 4 months thereafter. Exudative RD dimensions were assessed by B-scan ultrasonography (Eyecubed, Ellex) (thickness) and wide field fundus photography (Clarus 500, Zeiss) (largest basal diameter). The foveal involvement was assessed by OCT (Spectralis, Haidelberg).
Results :
Follow-up was 36 ±7 months. Marked (>50%) exudative retinal detachment regression was documented in 34 (81%) treated patients vs 16 (38%) untreated eyes (p= 0.00015). At six months follow-up, mean serous RD thickness reduced from 11.7 mm to 4.2 mm in the treated group vs 11.5 mm to 8.6 mm in the control group (p=0.0003), respectively. The serous RD largest basal diameter also reduced from 14.1 mm to 5.3 mm in the treated group versus 13.8 mm to 9.4 mm in the control group (p=0.0004), respectively. The foveal detachment resolution was documented in 22 vs 5 patients at two months (p=0.0007), in 27 vs 9 patients at four months (p=0.0007) and in 29 vs 12 patients at six months (p=0.0005), in the treated and control group, respectively. No retinal breaks secondary to the injection were documented. Neither steroid-induced increased IOP nor other short- or long-term side effects were documented.
Conclusions :
Intraoperative intravitreal dexamethasone implant induces earlier and marked exudative retinal detachment resolution after brachytherapy of posterior uveal melanoma.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.