Clinical outcomes of pars plana vitrectomy with endoresection in uveal melanoma primarily treated with plaque radiotherapy or proton beam therapy

Abstract

Background To describe the characteristics and outcomes of endoresection in patients with uveal melanoma previously treated with ruthenium brachytherapy or proton beam therapy.Methods In this retrospective study, data on the indication to perform endoresection, best-corrected visual acuity, tumor characteristics, surgery details, and characteristics of ruthenium brachytherapy or proton beam therapy were obtained.Results A total of 27 patients (12 men and 15 women) were included, with a median age of 63.5 (range 50.5) years. The indication for endoresection was exudative retinal detachment in 20 patients, glaucoma induced by tumor bleeding in 6 patients, and persistent inflammation in 1 patient. Ruthenium brachytherapy was performed in 6 patients, while 21 patients received proton beam therapy. In the ruthenium group, mean visual acuity before endoresection in Snellen was 0.099 +/- 0.197, which increased to 0.285 +/- 0.302 after endoresection (p = 0.043). In the proton beam group, mean visual acuity before endoresection was 0.030 +/- 0.044, which decreased to 0.020 +/- 0.036 after endoresection (p = 0.546). Mean change in visual acuity before and after endoresection was +0.186 +/- 0.249 in the ruthenium group and -0.009 +/- 0.053 in the proton beam group. Enucleation had to be performed in 1 eye in the ruthenium group and 8 eyes in the proton beam group. No surgery-related vascular events were observed.Conclusions Patients previously treated with ruthenium brachytherapy have favorable post-endoresection outcomes, opposed to those treated with proton beam therapy. Patient-specific counselling is important before endoresection, as there is a wide variety in expected outcomes.