title: Role of vitreoretinal surgery in maximizing treatment outcome following complications after proton therapy for uveal melanoma.
abstract: OBJECTIVE
  To assess the role of vitreoretinal surgery in maximizing treatment outcome following complications after proton therapy for uveal melanoma and to evaluate its safety.
  
  
  METHODS
  Retrospective chart study on 21 patients (2% of a total of 1,005 treated by proton therapy between January 2003 and August 2007) who had developed a complication requiring vitreoretinal surgery. Mean/median total follow-up after irradiation was 43/43 months (range, 12-70 months).
  
  
  RESULTS
  Indications for surgery included vitreous hemorrhage (n = 13), epimacular membrane (n = 5), rhegmatogenous retinal detachment (n = 1), combined vitreous hemorrhage with total serous retinal detachment (n = 1), and vitritis (n = 1). Mean/median interval for vitreoretinal surgery after irradiation was 21/20 months (range, 4-45 months), and mean/median follow-up after pars plana vitrectomy was 22/23 months (range, 2-56 months). Pars plana vitrectomy was combined with retinal photocoagulation (n = 5), air/gas (n = 5), or silicone oil tamponade (n = 1). Mean Snellen visual acuity was 20/200 (0-20/40) before and 20/100 (0-20/25) after pars plana vitrectomy. A transient postoperative rise in intraocular pressure was measured in seven patients. Four patients developed phthisis bulbi.
  
  
  CONCLUSIONS
  Vitreoretinal surgery was efficient in maximizing treatment outcome after proton therapy, as it allowed a better oncologic follow-up. Pars plana vitrectomy permitted panretinal photocoagulation to avoid neovascular glaucoma or retinal detachment repair. Macular surgery improved visual acuity, especially in anterior melanoma, whereas repeated surgery may increase the risk of enucleation.
authors.affiliation: Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland.
authors.forename: Bao-Khanh
authors.initials: BK
authors.lastname: Tran
authors.forename: Ann
authors.initials: A
authors.lastname: Schalenbourg
authors.forename: Etienne
authors.initials: E
authors.lastname: Bovey
authors.forename: Leonidas
authors.initials: L
authors.lastname: Zografos
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Wolfensberger
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D058450:Endotamponade / Q000379:methods; D005260:Female; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D017075:Laser Coagulation / Q000379:methods; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D061766:Proton Therapy / Q000009:adverse effects*; D011832:Radiation Injuries / Q000209:etiology / Q000601:surgery*; D012164:Retinal Diseases / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000532:radiotherapy*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy / Q000379:methods; D057586:Vitreoretinal Surgery / Q000379:methods*; D055815:Young Adult; D000098943:Uveal Melanoma