title: Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma.
abstract: AimsThe aim of this study was to compare transscleral resection technique performed without hypotensive anaesthesia (TSRWH) with iodine-125 brachytherapy (IBT) in the treatment of choroidal melanoma.Patients and methodsThis was a retrospective surgical cohort study. Nineteen eyes treated with TSRWH were matched with 53 eyes treated with IBT according to: tumour size, distance to fovea, distance to optic nerve, and follow-up time. Best-corrected visual acuity (BCVA), local recurrence, secondary enucleation, metastasis, overall and specific survival, and complications were evaluated.ResultsPatients treated with TSRWH had significantly better BCVA than those treated with IBT. The local recurrence risk was significantly higher when ciliary body was involved (HR=11.4, 95% CI 2.24-49.7, P=0.04). Metastatic disease was observed in 14 of 53 patients (26.4%) in the IBT group vs 3 patients (15.8%) in the TSRWH group (P=0.531). Multivariate analysis showed that iris involvement (HR=16.0, 95% CI 4.2-170.2, P=0.033) and large tumour (HR=2.3, 95% CI 1.2-4.8, P=0.04) increased the probability of metastasis. During follow-up, six patients (11.3%) in IBT group died vs two (10.5%) in the TSRWH group (P≥0.999). Nine patients required secondary enucleation: 5 (9.4%) in the IBT group vs 4 (21.1%) in the TSRWH group (P=0.231). The most common complications in IBT group were radiation-induced retinopathy (45.3%), neovascular glaucoma (28.3%), and macular oedema (24.5%), whereas rhegmatogenous retinal detachment (21.1%), ocular hypertension (21.1%), and submacular haemorrhage (15.8%) were the most frequent complications after TSRWH.ConclusionTSRWH is a technically challenging procedure. However, when performed successfully, this technique achieves better preservation of visual acuity than IBT and without the limitations inherent in hypotensive anaesthesia.
authors.affiliation: Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Caminal
authors.affiliation: Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Padrón-Pérez
authors.affiliation: Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Arias
authors.affiliation: Department of Preventive Medicine, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Masuet-Aumatell
authors.affiliation: Department of Brachytherapy, Catalan Institute of Oncology, Avinguda de la Gran Vía de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Gutiérrez
authors.affiliation: Department of Oncology, Catalan Institute of Oncology, Avinguda de la Gran Vía de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Piulats
authors.affiliation: Department of Brachytherapy, Catalan Institute of Oncology, Avinguda de la Gran Vía de l'Hospitalet, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pera
authors.affiliation: Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Català
authors.affiliation: Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Rubio
authors.affiliation: Department of Ophthalmology, Ocular Oncology and Vitreoretinal Service, Bellvitge University Hospital, Feixa Llarga s/n. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Arruga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000769:Anesthesia, Inhalation; D001918:Brachytherapy / Q000379:methods*; D002830:Choroid Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D019654:Lens Implantation, Intraocular; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures; D018918:Phacoemulsification; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery; D014792:Visual Acuity
chemical_list: D007457:Iodine Radioisotopes