title: Management of radiation-induced severe anophthalmic socket contracture in patients with uveal melanoma.
abstract: OBJECTIVE
  High-dose radiotherapy can cause contracture of the anophthalmic socket, but the incidence of this complication in patients with enucleation for uveal melanoma has not been reported previously. The authors reviewed the surgical management and outcomes in terms of successful prosthesis wear in patients with severe contracture of the anophthalmic socket treated with high-dose radiotherapy for high-risk uveal melanoma, and they estimated the relative risk of this complication.
  
  
  METHODS
  The medical records of all consecutive patients enrolled in a prospective uveal-melanoma tissue-banking protocol at the authors' institution who underwent enucleation between January 2003 and December 2010 were reviewed. Patients who underwent adjuvant radiotherapy of the enucleated socket were further studied.
  
  
  RESULTS
  Of the 68 patients enrolled in the prospective tissue-banking protocol, 12 had high-risk histologic features (e.g., extrascleral spread or vortex vein invasion) and were treated with 60 Gy of external beam radiotherapy after enucleation. Five of these patients (41.7%) experienced severe socket contracture precluding prosthesis wear. The median time to onset of contracture following completion of radiotherapy was 20 months. Three patients underwent surgery, which entailed scar tissue release, oral mucous membrane grafting, and socket reconstruction; 2 patients declined surgery. All 3 patients who had surgery experienced significant improvement of socket contracture that enabled patients to wear a prosthesis again.
  
  
  CONCLUSIONS
  High-dose radiotherapy after enucleation in patients with uveal melanoma caused severe socket contracture and inability to wear a prosthesis in approximately 40% of patients. Surgical repair of the contracted socket using oral mucous membrane grafting can allow resumption of prosthesis wear.
authors.affiliation: Section of Ophthalmology, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Qasiem J
authors.initials: QJ
authors.lastname: Nasser
authors.forename: Dan S
authors.initials: DS
authors.lastname: Gombos
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Williams
authors.forename: B Ashleigh
authors.initials: BA
authors.lastname: Guadagnolo
authors.forename: William H
authors.initials: WH
authors.lastname: Morrison
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
authors.forename: Beth M
authors.initials: BM
authors.lastname: Beadle
authors.forename: Elvia
authors.initials: E
authors.lastname: Canseco
authors.forename: Bita
authors.initials: B
authors.lastname: Esmaeli
mesh_terms: D015353:Eye Enucleation; D005137:Eye, Artificial; D006801:Humans; D008545:Melanoma / Q000601:surgery*; D009061:Mouth Mucosa / Q000637:transplantation; D013508:Ophthalmologic Surgical Procedures; D009915:Orbit / Q000528:radiation effects*; D009916:Orbital Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D020273:Orbital Implants; D011182:Postoperative Care; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011879:Radiotherapy Dosage; D011882:Radiotherapy, High-Energy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures; D015996:Survival Rate; D014604:Uveal Neoplasms / Q000601:surgery*