Plaque Radiation Can Preserve Vision in Extrascleral Uveal Melanoma Extension

Extrascleral uveal melanoma extension with occult intraocular tumors can be effectively controlled in patients using scleral patch graft repair and plaque radiation, preserving vision and preventing metastasis, research published in the British Journal of Ophthalmology shows.

Investigators at The New York Eye Cancer Center, New York, US, conducted a retrospective case series describing the management of patients with occult anterior uveal melanomas presenting with extrascleral extension.

The team evaluated 5 patients with small pigmented nodular masses on the episclera. They used slit-lamp photography and high-frequency ultrasound imaging to document and measure each lesion. For all patients, the clinicians confirmed the diagnosis of uveal melanoma by biopsy with lamellar sclerectomy and performed immediate scleral patch graft repair. They then treated each tumor with palladium-103 (¹⁰³Pd) ophthalmic plaque brachytherapy. 

The mean age of the patients was 52 years (range, 33-68). The patients underwent a mean follow-up duration of 80 months (range, 24-159). 

The investigators reported that the mean plaque diameter was 12 mm (range, 10-14 mm), and spanning 7 continuous days, they administered patients a mean apex prescription dose of 87 grays (Gy) (range, 82.3-99.2) to a tumor depth of 2 mm from the inner sclera. 

At a mean follow-up duration of 80 months, they found that visual acuities improved in 3 patients and were stable in 2 patients (mean pretreatment best-corrected visual acuity [BCVA], 20/20; range, 20/16-20/32; mean post-treatment BCVA, 20/16; range, 20/12.5-20/25). They reported that no patients experienced graft infection, scleromalacia or rejection. 

“Our patient’s clinical courses were found to be uncomplicated, in that scleral grafting was performed at the time of biopsy, and subsequent ¹⁰³Pd brachytherapy controlled the occult uveal melanomas,” the researchers explain. “This knowledge will help physicians with early intervention, thereby, saving the sight, eye and life of patients with occult uveal melanoma presenting with extrascleral extension.”

Limitations of the study included the retrospective design, small sample size, variable follow up, and lack of control group.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.