title: Vitreous hemorrhage after plaque radiotherapy for uveal melanoma.
abstract: OBJECTIVE
  The purpose of this article is to determine the incidence, etiology, management, and outcome of vitreous hemorrhage (VH) after plaque radiotherapy for uveal melanoma.
  
  
  METHODS
  Retrospective review of medical records.
  
  
  RESULTS
  Of 3,707 eyes treated with plaque radiotherapy for uveal melanoma, VH developed in 4.1% at 1 year, 15.1% at 5 years, and 18.6% at 10 years by Kaplan-Meier analysis. Presumed causes of VH included tumor necrosis (29%), proliferative radiation retinopathy (24%), posterior vitreous detachment (16%), vascular occlusion (5%), and unknown (19%). Tumor necrosis was the most common cause of VH early in the follow-up period (3% at 1 year), while proliferative radiation retinopathy was the most common source of VH later (6.2% at 15 years). The most common initial management was conservative observation for resolution in 48%, laser photocoagulation in 24%, and vitrectomy in 18%. After a mean follow-up period of 5 years, the VH was completely resolved in 41%, partially resolved in 19%, unresolved in 20%, worsened in 5%, and enucleation was necessary in 15%. By multivariable analysis, risk factors for development of VH were the presence of diabetic retinopathy at first visit (relative risk, 6.64), shorter tumor distance to the optic disc (relative risk, 1.07), greater initial tumor thickness (relative risk, 1.1), and break in the Bruch membrane (relative risk, 2.93). The rates of local tumor recurrence, extraocular extension, and distant metastasis in 74 patients who underwent vitrectomy for VH removal after tumor regression were similar to those in patients who did not have vitrectomy for VH.
  
  
  CONCLUSIONS
  Vitreous hemorrhage occurs after plaque radiotherapy for uveal melanoma in 15.1% of the patients by 5 years. The main factors predictive of VH included underlying diabetic retinopathy, closer tumor proximity to the disc, greater tumor thickness, and break in the Bruch membrane. After tumor regression, vitrectomy for blood removal appears to be safe.
authors.affiliation: Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Bianciotto
authors.forename: Carol L
authors.initials: CL
authors.lastname: Shields
authors.forename: Cesare
authors.initials: C
authors.lastname: Pirondini
authors.forename: Arman
authors.initials: A
authors.lastname: Mashayekhi
authors.forename: Minoru
authors.initials: M
authors.lastname: Furuta
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Shields
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects*; D002648:Child; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011832:Radiation Injuries / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D014823:Vitreous Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult; D000098943:Uveal Melanoma