Macular uveal melanoma treated with proton beam irradiation. 10-year follow-up observation with histopathologic correlation.
BACKGROUND
Although patients with choroidal melanoma within 3 mm of both the optic nerve and fovea are at higher risk for visual loss after proton beam irradiation, half of the patients in this study with visual acuity better than 20/200 before treatment maintained this level of vision for at least 2 years. Findings at a 10-year follow-up examination of a patient with macular uveal melanoma treated with proton beam irradiation are presented.


METHODS
A 65-year-old woman with macular uveal melanoma in one eye and optic atrophy in the fellow eye was treated with proton beam irradiation and evaluated for 10 years. The clinical course and histopathologic findings are presented.


RESULTS
The patient had optic atrophy in the fellow eye with visual acuity of 20/200, but maintained reading vision with the irradiated eye until she died of cardiac arrest. Histopathologic examination of the tumor-bearing eye showed a pigmented choroidal mass involving the macula. The mass consisted of plump spindle-shaped cells with small nuclei and indistinct nucleoli and a large number of pigment-laden macrophages.


CONCLUSIONS
It is demonstrated that long-term useful vision can be preserved in patients afflicted with macular uveal melanoma after proton beam irradiation.
Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
L H
LH
Young
E S
ES
Gragoudas
D000368:Aged; D002830:Choroid Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008266:Macula Lutea / Q000473:pathology*; D008545:Melanoma / Q000473:pathology* / Q000532:radiotherapy; D011882:Radiotherapy, High-Energy