title: 23-mm iodine-125 plaque for uveal melanoma: benefit of vitrectomy and silicone oil on visual acuity.
abstract: OBJECTIVE
  To review outcomes in mostly large uveal melanoma treated with a 23-mm-diameter iodine-125 plaque, the largest size available at our center, and the influence of vitrectomy and silicone oil 1000 centistokes for radiation attenuation.
  
  
  METHODS
  A one-to-one matched case-control comparison was performed. Case patients were treated with a 23-mm-diameter iodine-125 plaque and vitrectomy with silicone oil 1000-cSt placement. Control cases, treated with 23-mm plaque alone, were matched to cases with respect to tumor size and distance from tumor apex to optic nerve and fovea. Postoperative complications, visual acuity and metastasis were reviewed.
  
  
  RESULTS
  Twenty case patients with uveal melanoma treated with a 23-mm plaque were identified. The final logMAR vision was 0.83 in case patients and 2.06 in control patients (P = 0.0064); the change from pre-treatment to last follow-up logMAR vision was 0.70 in cases and 1.62 in controls (P = 0.019). Of good vision outcomes, 65 % of cases and 25 % of controls achieved vision ≥20/200 (P = 0.025). Of poor vision outcomes, 35 % of cases and 80 % of controls achieved vision <20/200 (P = 0.0053), and 5 % of cases and 35 % of controls achieved "light perception" or "no light perception" vision (P = 0.044). Thirty-nine of the 40 eyes (98 %) achieved local tumor control. Metastasis occurred in 15 % of cases and 45 % of controls (P = 0.082).
  
  
  CONCLUSIONS
  Iodine-125 brachytherapy for mostly large uveal melanoma is effective in achieving local tumor control. Furthermore, combining brachytherapy with vitrectomy and silicone oil 1000-cSt for radiation attenuation significantly improves vision over the use of plaque alone.
authors.affiliation: Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA. TMcCannel@jsei.ucla.edu.|Doheny Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA. TMcCannel@jsei.ucla.edu.|, 100 Stein PLZ, Los Angeles, CA, 90095, USA. TMcCannel@jsei.ucla.edu.
authors.forename: Tara A
authors.initials: TA
authors.lastname: McCannel
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Kamrava
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Demanes
authors.affiliation: Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Lamb
authors.affiliation: Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Bartlett
authors.affiliation: Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Almanzor
authors.affiliation: Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Chun
authors.affiliation: Stein Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.|Doheny Eye Institute, Department of Ophthalmology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
mesh_terms: D001707:Biopsy, Needle; D001918:Brachytherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008279:Magnetic Resonance Imaging; D008297:Male; D008545:Melanoma / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012827:Silicone Oils; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014604:Uveal Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*; D000098943:Uveal Melanoma
chemical_list: D007457:Iodine Radioisotopes; D012827:Silicone Oils
keywords: Choroidal melanoma; Ocular melanoma; Radiation retinopathy; Silicone oil; Uveal melanoma; Vitrectomy