Plaque radiotherapy for juxtapapillary choroidal melanoma: treatment complications and visual outcomes in 650 consecutive cases.

Importance: The treatment of juxtapapillary choroidal melanoma is challenging because of the proximity of the tumor to visually important structures.

Objective: To report the complications of treatment of juxtapapillary choroidal melanoma with plaque radiotherapy.

Design, Setting, And Participants: In this retrospective case series of patients from the Ocular Oncology Service, Wills Eye Hospital, 650 consecutive eyes with juxtapapillary choroidal melanoma (≤1 mm to optic disc) treated with plaque radiotherapy from October 1, 1974, through November 30, 2005, were studied.

Main Outcomes And Measures: Kaplan-Meier analysis of rates of radiation complications, secondary enucleation, and visual acuity outcomes.

Results: The 5-year (10-year) rate of nonproliferative retinopathy was 66% (75%); proliferative retinopathy, 24% (32%); maculopathy, 56% (65%); papillopathy, 61% (77%); cataract, 66% (80%); neovascular glaucoma, 15% (22%); vitreous hemorrhage, 35% (42%); and secondary enucleation, 16% (26%). Visual acuity of 20/200 or worse occurred in 54% (87%), and loss of more than 5 lines of Snellen visual acuity was found in 45% (78%).

Conclusions And Relevance: Among this case series, plaque radiotherapy for juxtapapillary choroidal melanoma commonly led to retinopathy and papillopathy, but globe retention was 84% at 5 years. Vision loss should be anticipated in 45% by 5 years. Plaque radiotherapy remains a suitable choice for the treatment of juxtapapillary melanoma with a high globe retention rate.