Plaque Radiotherapy for Posterior Uveal Melanoma (PUM) in 4000 Eyes: Risk Factors for ≥15-Letter Visual Acuity Loss in the Pre-Anti-VEGF Era.
Publication/Presentation Date
5-19-2026
Abstract
PURPOSE: To evaluate clinical factors that lead to ≥15-letter visual acuity loss following plaque radiotherapy of posterior uveal melanoma (PUM) in the pre-anti-vascular endothelial growth factor (anti-VEGF) era.
METHODS: We reviewed data on 4000 consecutive patients with plaque-irradiated PUM managed between May 1976 and November 2008 to identify parameters predictive of ≥15-letter vision loss.
RESULTS: Data included median patient age (60 years), diabetes mellitus (11%), median tumor diameter (11.0 mm) and thickness (4.5 mm), and median distance to optic disc (4.0 mm) and foveola (3.0 mm). Kaplan-Meier analyses revealed ≥15-letter loss at 1 versus (vs.) 3 vs. 5 vs. 10 years in 30% vs. 60% vs. 73% vs. 82% of patients. Multivariate analyses revealed factors predictive of ≥15-letter loss included greater tumor thickness (p< 0.01, hazard ratio [HR] 1.14), shorter distance to foveola (p< 0.01, HR 0.93), greater radiation dose to foveola (p< 0.01, HR 1.01) and lens (p< 0.01, HR 1.01), and presence of diabetes mellitus (p< 0.01, HR 1.11). For small PUM, multivariate risk factors included older age (p< 0.01), diabetes mellitus (p< 0.01), and shorter distance to foveola (p< 0.02); for medium PUM, risk factors included greater tumor thickness (p< 0.01), shorter distance to foveola (p< 0.01), and less (but shorter) radiation dose to foveola (p< 0.01); for large PUM, risk factors included greater tumor thickness (p< 0.01) only.
CONCLUSIONS: In the pre-anti-VEGF days, following treatment of PUM with plaque radiotherapy, clinical and treatment factors predictive of ≥15-letter visual acuity loss included greater tumor thickness, shorter distance to foveola, greater radiation dose to foveola and lens, and presence of diabetes mellitus.
ISSN
1539-2864
Published In/Presented At
Shields, C. L., Medina, R. J., Sener, H., Botros, S., Choudhury, R., Khan, A., Gandhi, P., Miller, E. G., Attaseth, T., Lally, S. E., & Shields, J. A. (2026). Plaque Radiotherapy for Posterior Uveal Melanoma (PUM) in 4000 Eyes: Risk Factors for ≥15-Letter Visual Acuity Loss in the Pre-Anti-VEGF Era. Retina (Philadelphia, Pa.), 10.1097/IAE.0000000000004887. Advance online publication. https://doi.org/10.1097/IAE.0000000000004887
Disciplines
Medicine and Health Sciences
PubMedID
42153890
Department(s)
Medical Education
Document Type
Article