title: Post-brachytherapy tumor endoresection for treatment of toxic maculopathy in choroidal melanoma.
abstract: OBJECTIVE
  Toxic tumor syndrome may occur when the irradiated choroidal melanoma releases cytokines, by exudation from irradiated ischemic tissue. We report our experience and outcomes in a series of post-brachytherapy tumor endoresection to mediate radiation complications.
  
  
  METHODS
  Patients who underwent endoresection of a choroidal melanoma treated with iodine-125 plaque brachytherapy were evaluated. Baseline patient and tumor parameters were tabulated.
  
  
  RESULTS
  Five patients underwent post-brachytherapy tumor endoresection with intraocular gas or silicone oil tamponade. Three of the five patients underwent concomitant phacoemulsification with intraocular lens placement. Initial tumor height ranged from 2.03-8.91 mm (mean 5.81 mm). Time between brachytherapy and endoresection ranged from 13-62 months (mean 26.8 months), and total follow-up time from brachytherapy ranged from 2.5-9.75 years (mean 5.2 years). Vision post-brachytherapy and pre-endoresection ranged from 20/30 to 20/400. Final visual acuity ranged from 20/70 to no light perception. One patient developed neovascular glaucoma. Radiation maculopathy increased in all patients. One patient developed metastasis at last follow-up. No patient developed exudative retinal detachment, none had local treatment failure, and none required enucleation.
  
  
  CONCLUSIONS
  Although tumor endoresection post-brachytherapy is a technically feasible procedure, all patients in our series experienced progressive radiation maculopathy with gradual visual decline.
authors.affiliation: Department of Ophthalmology, The Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA 90095, USA. tmccannel@jsei.ucla.edu
authors.forename: T A
authors.initials: TA
authors.lastname: McCannel
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D002830:Choroid Neoplasms / Q000378:metabolism / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000628:therapy*; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology* / Q000473:pathology; D012164:Retinal Diseases / Q000209:etiology* / Q000473:pathology; D012429:Ruthenium Radioisotopes / Q000009:adverse effects; D014821:Vitrectomy / Q000379:methods*
chemical_list: D012429:Ruthenium Radioisotopes