Pigmented episcleral deposits after brachytherapy of uveal melanoma.
OBJECTIVE
To describe the characteristics and evolution of pigmented episcleral deposits after brachytherapy for uveal melanoma to determine their origin and association with melanoma-related mortality.


METHODS
Noncomparative case series.


METHODS
Two hundred eleven patients (108 males, 103 females; median age, 61 years; range, 14-88 years) who were treated with a single ruthenium and iodine plaque therapy (median dose to tumor base, 475 Gy and 392 Gy, respectively) for a choroidal and ciliary body melanoma. Median tumor diameter and height were 12 mm and 5.5 mm, respectively. Eighty-eight patients were treated prospectively during the study.


METHODS
The number and location of pigmented episcleral deposits were recorded under the slit lamp during each visit after brachytherapy. The association of the deposits with tumor characteristics and survival was analyzed with logistic regression and Kaplan-Meier analysis, respectively.


METHODS
Number and location of episcleral deposits, melanoma-related mortality.


RESULTS
The pigmented episcleral deposits ranged from black and brownish spots to slightly thickened patches. Most deposits appeared within the first 6 months after brachytherapy. By 1 year, 85% (95% confidence interval, 77-93) of eyes had at least 1 deposit (median, 6). The deposits increased in number until 7 years from irradiation, and decreased with increasing distance from tumor center. An association between the number of deposits at 1 and 2 years and subsequent melanoma-related mortality could not be confirmed (P = 0.80 and P = 0.31, respectively).


CONCLUSIONS
Pigmented macrophage-related episcleral deposits are found in most eyes with uveal melanoma after brachytherapy. Their association with plaque size and isotope rather than with tumor size suggests that radiation atrophy of retinal pigment epithelium and choroid in addition to tumor regression contributes to the formation of the deposits. Knowledge of their existence may save patients from unnecessary enucleation.
Toivonen
Päivi
P
Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland. paivi.toivonen@hus.fi
Kivelä
Tero
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001284:Atrophy; D001918:Brachytherapy / Q000009:adverse effects*; D002829:Choroid / Q000473:pathology / Q000528:radiation effects; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D008264:Macrophages / Q000378:metabolism / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000401:mortality / Q000532:radiotherapy*; D008875:Middle Aged; D010857:Pigment Epithelium of Eye / Q000473:pathology / Q000528:radiation effects; D010859:Pigmentation Disorders / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D012429:Ruthenium Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use; D015422:Scleral Diseases / Q000209:etiology* / Q000473:pathology; D015996:Survival Rate; D014604:Uveal Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D000097382:CD68 Molecule
D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D007457:Iodine Radioisotopes; D012429:Ruthenium Radioisotopes; C067980:CD68 antigen, human; D000097382:CD68 Molecule