title: Endodrainage, Tumor Photocoagulation, and Silicone Oil Tamponade for Primary Exudative Retinal Detachment due to Choroidal Melanoma Persisting after Proton Beam Therapy.
abstract: BACKGROUND
  Choroidal melanoma is frequently accompanied by an exudative retinal detachment that can persist after proton beam therapy. This study investigates whether vitrectomy without tumor resection improves the clinical outcome.
  
  
  METHODS
  This is a retrospective interventional case series. Twenty patients with choroidal melanoma with exudative retinal detachment involving the macula were treated by vitrectomy, endodrainage, photocoagulation, and silicone oil tamponade after proton beam therapy.
  
  
  RESULTS
  The mean follow-up was 38.4 months (median 21.5, range 12.0-122.0). The mean time between proton beam therapy and surgery was 4.5 months (range 0.1-9.2). Reattachment was achieved in 95% of the patients after one vitrectomy. One patient was lost to follow-up because enucleation was performed after 45.9 months due to a secondary glaucoma. Mean visual acuity decreased from 1.1 to 1.8 logMAR before vitrectomy and after 4 years, respectively. No patient showed local tumor recurrence. Metastatic disease was present in 1 patient after 15.2 months, and this patient died after 19.2 months.
  
  
  CONCLUSIONS
  Vitrectomy is indicated after therapeutic proton beam irradiation in patients who present with persisting exudative retinal detachment involving the macula and high local or systemic risk factors for hemorrhagic complications, thus excluding endoresection.
authors.affiliation: Department of Ophthalmology, Charité University Medicine Berlin, Germany.
authors.forename: Ira
authors.initials: I
authors.lastname: Seibel
authors.affiliation: Department of Ophthalmology, Charité University Medicine Berlin, Germany; BerlinProtonen, Helmholtz-Zentrum Berlin für Materialien und Energie, Berlin, Germany.
authors.forename: Dino
authors.initials: D
authors.lastname: Cordini
authors.affiliation: Department of Ophthalmology, Charité University Medicine Berlin, Germany; Klinik für Augenheilkunde an den DRK Kliniken Berlin/Westend, Berlin, Germany.
authors.forename: Gregor
authors.initials: G
authors.lastname: Willerding
authors.affiliation: Department of Ophthalmology, Charité University Medicine Berlin, Germany.
authors.forename: Aline Isabel
authors.initials: AI
authors.lastname: Riechardt
authors.affiliation: Department of Ophthalmology, Charité University Medicine Berlin, Germany.
authors.forename: Antonia Maria
authors.initials: AM
authors.lastname: Joussen
keywords: Choroidal melanoma; Endodrainage; Exudative retinal detachment; Proton beam therapy