Retrospective, nonrandomized interventional case series.
PARTICIPANTS:
Tumor control, recurrence, poor visual acuity, enucleation,
metastasis, and radiation complications.
RESULTS: There were 32 eyes with residual (n = 12) or recurrent (n = 20) iris
melanoma after surgical resection that were treated with
iodine-125 plaque
radiotherapy. The residual
melanoma was evident clinically in 3 cases and histopathologically in 9; plaque
radiotherapy was delivered at a mean interval of 2 months after resection. For the recurrent cases, the mean interval from initial
tumor resection to detection of recurrence was 58 months, at which time plaque
radiotherapy was applied. For all cases, the mean
tumor basal diameter was 6 mm (range, 1-13) and thickness was 2 mm (range, 0.8-4.0) at the time of
radiotherapy. Anterior chamber seeding was present in 26 (81%) eyes and
glaucoma in 11 (34%) eyes. Visual acuity at presentation was good (20/20-20/50) in 27 (84%), intermediate (20/60-20/150) in 3 (9%), and poor (≤20/200) in 2 eyes (6%). At 6 years after plaque
radiotherapy, outcomes included complete
tumor control in 87%, poor visual acuity in 9%, enucleation in 13% (for reasons of
tumor recurrence [n = 3] and severe
glaucoma [n = 1]), and
metastasis in 3%. At 6 years, radiation complications included corneal epitheliopathy in 6%, scleral
necrosis in 3%,
cataract in 53%, elevated intraocular pressure (from
tumor or
radiotherapy) in 19%, and
macular edema in 6%.
CONCLUSIONS:
Iodine-125 plaque
radiotherapy is effective in the management of residual or recurrent iris
melanoma after surgical resection, providing
tumor control in 87% of patients at 6 years and avoiding enucleation in most cases.