Long-term choroidal vascular changes after iodine brachytherapy versus transpupillary thermotherapy for choroidal melanoma.
OBJECTIVE
To compare long-term choroidal vascular changes after iodine-125 brachytherapy (IBT) versus transpupillary thermotherapy (TTT) used as primary treatment of small choroidal melanoma.


METHODS
Ninety-five small choroidal melanomas were randomized: 49 eyes with TTT and 46 eyes with IBT alone. Fluorescein and indocyanine green angiography (ICGA) were performed at 3-month intervals during the first year, and every 6 months thereafter.


RESULTS
Mean follow-up was 56.2 months (range, 24-118 months; SD, 22.6). Tumor regressed in 45 (92%) TTT-treated vs 45 (98%) IBT-treated eyes (p=0.397). Four TTT-treated and one IBT-treated tumor recurred. Occlusion of choriocapillaris was present in all TTT and IBT cases. Closure of medium and large choroidal vessels was observed in 17 (35%) TTT-treated vs 44 (96%) IBT-treated eyes (p<0.001). Choroidal vascular remodeling was detected in 20 (41%) TTT-treated and 16 (35%) IBT-treated eyes (p=0.693). Retinochoroidal anastomosis was present in 4 of the 37 (11%) TTT-treated eyes with patency of medium and large choroidal vessels, but never observed in the IBT-treated eyes, and was associated with tumor recurrence. Among IBT-treated eyes, segments of choroidal vascular wall ICG staining and choroidal aneurysmal changes were detected in 30 (65%) and 7 (15%), respectively. These changes were never detected in TTT-treated cases (p<0.0001 and p=0.015, respectively).


CONCLUSIONS
The pattern of tumor choroidal vascular changes following IBT and TTT differs. TTT is less effective in closing all tumor vasculature. The role of long-term choroidal vascular remodeling observed after these two treatments needs longer follow-up.
Pilotto
Elisabetta
E
Department of Ophthalmology, University of Padova, Padova, Italy. elisabetta.pilotto@unipd.it
Vujosevic
Stela
S
De Belvis
Valentina
V
Parrozzani
Raffaele
R
Boccassini
Barbara
B
Midena
Edoardo
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D002829:Choroid / Q000098:blood supply*; D002830:Choroid Neoplasms / Q000532:radiotherapy*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects* / Q000379:methods; D007208:Indocyanine Green; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000209:etiology*; D014792:Visual Acuity
D004396:Coloring Agents; D007457:Iodine Radioisotopes; D007208:Indocyanine Green