Rate of resolution of exudative retinal detachment after plaque radiotherapy for uveal melanoma.
OBJECTIVE
To determine the clinical relevance of exudative retinal detachment (ERD) and the rate of ERD resolution after plaque radiotherapy of posterior uveal melanomas.


METHODS
Retrospective, nonrandomized study of 135 consecutive patients with posterior uveal melanoma treated by iodine 125 plaque radiotherapy. Extent of ERD and tumor thickness were assessed before radiotherapy and at postoperative follow-up visits. Local tumor control was assessed at each follow-up visit.


RESULTS
An ERD was present in 71 patients (53%) and was a risk factor for local treatment failure (P =.03). The ERD resolved after radiotherapy in 59 (83%) of the 71 patients. The ERD resolved within 1 year in 64 patients (90%) (mean time to resolution, 5.6 months). The rate of ERD resolution correlated with the rate of decrease in tumor thickness (P =.004). The ERD did not resolve and the tumor thickness continued to increase in 5 patients, who required further intervention. A recurrent retinal detachment developed in 5 patients, who were diagnosed as having rhegmatogenous retinal detachment (3 patients) and lipid exudation secondary to tumor vasculopathy (2 patients). Two patients with local tumor recurrence did not develop a recurrent ERD. Local tumor control was achieved in 130 patients (96%).


CONCLUSIONS
An ERD may be a risk factor for local failure after plaque radiotherapy for uveal melanoma. If an ERD does not resolve within 9 to 12 months of radiotherapy and the tumor is not regressing, treatment failure should be suspected. A recurrent ERD does not necessarily represent local tumor recurrence.
Harbour
J William
JW
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, PO Box 8069, 660 S Euclid Ave, St Louis, MO 63110, USA. harbour@vision.wustl.edu
Ahmad
Saad
S
El-Bash
Mohammed
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D005122:Exudates and Transudates; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D008545:Melanoma / Q000150:complications / Q000503:physiopathology / Q000532:radiotherapy*; D008875:Middle Aged; D012008:Recurrence; D012163:Retinal Detachment / Q000209:etiology / Q000503:physiopathology*; D012189:Retrospective Studies; D012307:Risk Factors; D014604:Uveal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000532:radiotherapy*
D007457:Iodine Radioisotopes