title: Visual outcome of eyes with malignant melanoma of the uvea after ruthenium plaque radiotherapy.
abstract: OBJECTIVE
  To analyze the overall visual outcome in 100 consecutive eyes with malignant uveal melanoma irradiated with ruthenium-106 plaques between 1981 and 1991.
  
  
  METHODS
  The follow-up ranged from 4 months to 10.1 years (median 3.0 years). Scattergrams of equal follow-up periods, life-table survival analysis, and Cox's proportional hazards analysis were used to analyze visual outcome.
  
  
  RESULTS
  VA increased for some time in 14 eyes. By 3 years, VA of at least 20/70, 20/200, counting fingers, and light perception were retained in 27%, 41%, 67% and 82% of eyes, respectively. Macular pathology cause loss of reading vision; neovascular glaucoma or enucleation caused loss of light perception. In univariate analysis, large tumor size (height > 5 mm or TNM class T3) predicted visual loss of all VA levels. For the loss of light perception, the tumor's largest basal diameter > 15 mm reached significance. In Cox's multivariate analysis tumor height > 5 mm was the only significant independent risk indicator for loss of VA levels 20/70 and 20/200. For the level CF, largest basal tumor diameter also reached significance, but location of the tumor within 1 disc diameter of the optic disc, either alone or in addition to the fovea, had the greatest risk ratio (6.3, 95% CI 4.1-9.8). For losing light perception, large TNM size (T3) was the strongest risk indicator (risk ratio 10.0; 95% CI 4.5-22.5), followed by proximity of the tumor to the optic disc (risk ratio 4.3, 95% CI 2.4-7.8).
  
  
  CONCLUSIONS
  Ruthenium brachytherapy may retain vision in an eye with a malignant melanoma of the uvea for a considerable period of time. The data presented are useful in patient counseling and allow comparison to subsequent series.
authors.affiliation: Department of Ophthalmology, Helsinki University Central Hospital, Finland.
authors.forename: P
authors.initials: P
authors.lastname: Summanen
authors.forename: I
authors.initials: I
authors.lastname: Immonen
authors.forename: T
authors.initials: T
authors.lastname: Kivelä
authors.forename: P
authors.initials: P
authors.lastname: Tommila
authors.forename: J
authors.initials: J
authors.lastname: Heikkonen
authors.forename: A
authors.initials: A
authors.lastname: Tarkkanen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000503:physiopathology / Q000532:radiotherapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012429:Ruthenium Radioisotopes / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy*; D014786:Vision Disorders / Q000209:etiology; D014792:Visual Acuity
chemical_list: D012429:Ruthenium Radioisotopes