Secondary Enucleations for Uveal Melanoma: A 7-Year Retrospective Analysis.
OBJECTIVE
To describe the indications for secondary enucleations in uveal melanoma and analyze associations and outcomes.


METHODS
Retrospective interventional case series.


METHODS
Data of patients who underwent secondary enucleation for uveal melanoma in the London Ocular Oncology Service, between 2008 and 2014, were retrieved from medical records analyzed. Cox regression model was performed to analyze associations with secondary enucleation and metastases and Kaplan-Meier estimates to assess the probability of metastatic spread and death.


RESULTS
During the study period 515 enucleations were performed for uveal melanoma, 99 (19%) of which were secondary enucleations. Tumors were located at the ciliary body in 21 eyes (21%), juxtapapillary in 31 (31%), and choroid elsewhere in 47 (48%). Primary treatment included Ru(106) plaque radiotherapy, proton beam radiotherapy, and transpupillary thermotherapy in 85, 11, and 3 eyes, respectively. Indications for secondary enucleation were tumor recurrence in 60 (61%), neovascular glaucoma in 21 (21%), and tumor nonresponse in 18 eyes (18%). Twenty patients (20%) were diagnosed with metastasis and 12 out of 20 died of metastatic spread. On multivariate analysis, juxtapapillary tumor location was found to associate with tumor nonresponse (P = .004) and nonresponding patients with metastatic spread (P = .04).


CONCLUSIONS
Indications for secondary enucleations for uveal melanoma were tumor recurrence, neovascular glaucoma, and tumor nonresponse. This review identified a possible high-risk group (nonresponse), which proved radioresistant to treatment. These tumors were more frequently found in the juxtapapillary location and were associated with metastatic spread.
Moorfields Eye Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom. Electronic address: didifabian@gmail.com.
Ido Didi
ID
Fabian
Moorfields Eye Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom.
Oren
O
Tomkins-Netzer
St Bartholomew's Hospital, London, United Kingdom.
Ian
I
Stoker
Moorfields Eye Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom.
Amit K
AK
Arora
Moorfields Eye Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom; University College London Institute of Ophthalmology, London, United Kingdom.
Mandeep S
MS
Sagoo
Moorfields Eye Hospital, London, United Kingdom; St Bartholomew's Hospital, London, United Kingdom.
Victoria M L
VM
Cohen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015353:Eye Enucleation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D009367:Neoplasm Staging; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014792:Visual Acuity; D055815:Young Adult; D000098943:Uveal Melanoma