Plaque Radiotherapy for Posterior Uveal Melanoma in 4000 Eyes: Analysis of ≥15-Letter Visual Acuity Loss in the Pre-Anti-VEGF Era.
Publication/Presentation Date
4-6-2026
Abstract
PURPOSE: To evaluate ≥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 managed between 1976 and 2008 regarding patient demographics, tumor features, treatment factors, and ≥15-letter visual acuity loss over time based on tumor size category of small (0-3.0 mm thickness), medium (3.1-8.0 mm) and large (>8.0 mm).
RESULTS: Of the 4000 patients, there were small (n=1011 eyes, 25%), medium (n=2445, 61%), and large (n=544, 14%) tumor categories. The PUM touched the optic disc (n=560, 14%) and/or extended under the foveola (n=644, 16%). Comparative analysis (small versus (vs.) medium vs. large PUM) showed small tumor category with demographics of younger age (p< 0.01) and greater Caucasian race (p< 0.05), presenting features of visual acuity ≥20/40 (p< 0.01) and closer proximity to the optic disc (p< 0.01) and foveola (p< 0.01), and radiation treatment parameters most intense at the foveola (p< 0.01). The median radiation dose to the optic disc (3100 vs. 3257 vs. 4336 centiGray [cGy], p< 0.01) and the foveola (3964 vs. 3864 vs. 4598 cGy, p< 0.01) was noted. Overall, ≥15-letter loss was found in 62% patients at median 16 months. By Kaplan-Meier analysis of all cases, ≥15-letter loss at 1 vs. 2 vs. 3 vs. 5 vs. 10 years was present in 30% vs. 48% vs. 60% vs. 73% vs. 82%.
CONCLUSIONS: In the pre-anti-VEGF days, following treatment of PUM with plaque radiotherapy, visual acuity showed ≥15-letter loss in 62% of patients at median 16 months.
ISSN
1539-2864
Published In/Presented At
Shields, C. L., Medina, R. J., Sener, H., Zafar, A., Warszawski, N., Miller, E. G., Patel, O. V., Ahmed, A. M., Lockridge, C. J., Makkithaya, N., Duffy, A. O., Attaseth, T., Lally, S. E., & Shields, J. A. (2026). Plaque Radiotherapy for Posterior Uveal Melanoma in 4000 Eyes: Analysis of ≥15-Letter Visual Acuity Loss in the Pre-Anti-VEGF Era. Retina (Philadelphia, Pa.), 10.1097/IAE.0000000000004849. Advance online publication. https://doi.org/10.1097/IAE.0000000000004849
Disciplines
Education | Medical Education
PubMedID
41940757
Department(s)
Department of Education
Document Type
Article