Radiation retinopathy and optic neuropathy after proton beam therapy of choroidal melanoma [article]

Johanna Tillner, Universitätsbibliothek Der FU Berlin, Universitätsbibliothek Der FU Berlin
2017
Radiation therapy of choroidal melanomas has replaced enucleation as the treatment of choice since metastasis and mortality rates were proven comparable. This development has shifted the focus more towards functional outcome due to the frequent occurrence of radiation-induced complications. Among them, radiation retinopathy and optic neuropathy are two of the major vision compromising complications. Purpose: The aim of this retrospective study was to investigate radiation-induced retinopathy
more » ... optic neuropathy after proton beam irradiation in choroidal melanomas in a long-term follow-up with the focus on determining incidence rates, risk factors and visual prognosis. Methods: We evaluated 1085 patients with choroidal melanomas who received proton beam therapy with a total dose of at least 60 cobalt gray equivalents (CGE) as primary tumor treatment at the Department of Ophthalmology of the Charité - Universitätsmedizin Berlin in cooperation with the Helmholtz-Center Berlin between June 1998 and December 2013. Excluded were all patients with a follow-up of less than 12 months and patients who underwent tumor resection or endodrainage vitrectomy. Data were obtained from an existing data base and by reviewing electronic records and statistically analyzed using SPSS. Results: The mean follow-up was 54.4 months (12.0 – 170.4 months). 790 patients (72.8%) developed radiation retinopathy after a mean latency of 23.0 months (1.4 – 99.8 months) and 472 patients (43.5%) developed optic neuropathy after a mean latency of 25.6 months (0.2 – 125.7 months) since proton radiotherapy. Initial mean visual acuity was 0.3 logMAR dropping to final visual results of 0.5 logMAR in complication-free patients, 1.0 logMAR if solely retinopathy had been diagnosed or 1.5 logMAR in patients with diagnosed optic neuropathy. Tumor distance to the equator and its proximity to the optic disc, as well as radiation dose on fovea and optic disc were identified as significant predictive factors for the appearance of optic neuropathy. T [...]
doi:10.17169/refubium-6368 fatcat:op36c2ajr5afhghvgwfdgs2vse