Vision after palladium plaque for choroidal melanoma: 63.7% kept 20/200 or better at 20 years

Design

Retrospective single-centre cohort with minimum 10-year follow-up

Population

170 patients with choroidal melanoma treated with palladium-103 plaque brachytherapy

Primary outcome

Tumour control, ocular conservation and visual acuity

Effect

Local control 100%; VA 20/200 or better retained: 92.7% (12 y), 87.0% (15 y), 63.7% (20 y)

This retrospective cohort from one eye cancer centre followed 170 patients for at least ten years after palladium-103 plaque brachytherapy for choroidal melanoma. Local tumour control was 100%. One eye (0.6%) was enucleated, for neovascular glaucoma and patient choice.

Kaplan-Meier estimates of retaining visual acuity of 20/200 or better were 92.7% at 12 years, 87.0% at 15 years and 63.7% at 20 years. Radiation retinopathy was managed with anti-VEGF injections, intravitreal corticosteroids and laser. Tumours nearer the fovea received higher foveal doses and had poorer vision, and juxtapapillary and circumpapillary tumours had the highest rates of vision loss.

The cohort required at least ten years of follow-up, so it excludes patients who died or were lost earlier, and it comes from a single specialist centre. The results are useful for counselling about long-term vision and about the need for lifelong retinopathy surveillance, not as a comparison with other radiation methods.

• Local control was 100% in 170 patients with at least ten years of follow-up.
• Vision of 20/200 or better was kept in 92.7% at 12 years and 63.7% at 20 years.
• Tumours near the fovea or optic disc had the worst visual outcomes.
• Plan lifelong surveillance for radiation retinopathy and glaucoma.
• Use these figures in counselling, noting they come from one specialist centre.

Why it matters

It provides long-term vision data for counselling that most series, with shorter follow-up, cannot give.

Don't overread it

Requiring ten years of follow-up excludes early deaths and losses, so it can overstate outcomes for all treated patients, and it does not compare plaque types.

The statistics, in plain English

A Kaplan-Meier estimate of 63.7% at 20 years means that about two in three eyes were expected to keep 20/200 or better at that point, but few patients were followed that long, so the late estimates are the least precise.

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