VISUAL OUTCOME OF EYES WITH MALIGNANT-MELANOMA OF THE UVEA AFTER RUTHENIUM PLAQUE RADIOTHERAPY

BACKGROUND AND OBJECTIVE: To analyze the overall visual outcome in 100 consecutive eyes with malignant uveal melanoma irradiated with ruthen ium-106 plaques between 1981 and 1991. PATIENTS AND METHODS: The follo w-up ranged from 4 months to 10.1 years (median 3.0 years). Scattergra ms of equal follow-up periods, life-table survival analysis, and Cox's proportional hazards analysis were used to analyze visual outcome. RE SULTS: VA increased for some time in 14 eyes. By 3 years, VA of at lea st 20/70, 20/200, counting fingers, and light perception were retained in 27%, 41%, 67% and 82% of eyes, respectively. Macular pathology cau se loss of reading vision; neovascular glaucoma or enucleation caused loss of light perception. In univariate analysis, large tumor size (he ight >5 mm or TNM class T3) predicted visual loss of all VA levels. Fo r the loss of light perception, the tumor's largest basal diameter > 1 5 mm reached significance. In Cox's multivariate analysis tumor height > 5 mm was the only significant independent risk indicator for loss o f VA levels 20/70 and 20/200. For the level CF, largest basal tumor di ameter also reached significance, but location of the tumor within 1 d isc diameter of the optic disc, either alone or in addition to the fov ea, had the greatest risk ratio (6.3, 95% CI 4.1-9.8). For losing ligh t perception, large TNM size (T3) was the strongest risk indicator (ri sk ratio 10.0; 95% CI 4.5-22.5), followed by proximity of the tumor to the optic disc (risk ratio 4.3, 95% CI 2.4-7.8). CONCLUSION: Rutheniu m brachytherapy may retain vision in an eye with a malignant melanoma of the uvea for a considerable period of time. The data presented are useful in patient counseling and allow comparison to subsequent series .