Periocular triamcinolone for prevention of macular edema after iodine 125 plaque radiotherapy of uveal melanoma.
OBJECTIVE
To investigate the potential benefit of periocular depot triamcinolone in the prevention of macular edema after iodine 125 plaque radiotherapy for uveal melanoma.


METHODS
This comparative, nonrandomized, interventional study included 87 patients with uveal melanoma who underwent plaque radiotherapy. The triamcinolone group included 55 consecutive patients who were treated with 40 mg of periocular triamcinolone at the time of plaque application and 4 months and 8 months later. The comparison group comprised 32 consecutive patients treated with plaque radiotherapy without triamcinolone. Patients were evaluated at 4 months, 8 months, 12 months, 18 months, and 24 months after plaque application with clinical examination, fundus photography, and optical coherence tomography (OCT). The associations of clinical variables with the development of OCT-evident macular edema (the main outcome measure) were investigated using Cox proportional hazards analysis.


RESULTS
By multivariate analysis, eyes treated with periocular triamcinolone had a significant reduction in the risk of radiation-induced macular edema (P = 0.002; hazard estimate = 0.49; 95% confidence interval, 0.17- 0.80). Adverse effects associated with periocular triamcinolone treatment included elevation of intraocular pressure (7% of cases) and blepharoptosis (5% of cases).


CONCLUSIONS
Periocular triamcinolone treatment significantly lowered the risk of macular edema after plaque radiotherapy for uveal melanoma in this series but did not significantly alter the rate of vision loss at 24 months of follow-up.
Horgan
Noel
N
Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Shields
Carol L
CL
Mashayekhi
Arman
A
Teixeira
Luiz F
LF
Materin
Miguel A
MA
O'Regan
Myra
M
Shields
Jerry A
JA
D001918:Brachytherapy / Q000009:adverse effects*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D007457:Iodine Radioisotopes / Q000009:adverse effects*; D008266:Macula Lutea / Q000528:radiation effects*; D008269:Macular Edema / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000209:etiology / Q000517:prevention & control*; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D014822:Vitreous Body
D005938:Glucocorticoids; D007457:Iodine Radioisotopes; D014222:Triamcinolone Acetonide