LONG-TERM VISUAL OUTCOME OF RADIATED UVEAL MELANOMAS IN EYES ELIGIBLEFOR RANDOMIZATION TO ENUCLEATION VERSUS BRACHYTHERAPY

Aims-To determine the long term visual outcome of patients who were el igible for randomisation to enucleation versus brachytherapy in a US c ollaborative ocular melanoma study (COMS) but were treated with either helium ion or I-125 radioactive plaque therapy. Method-A retrospectiv e analysis was performed of 426 ciliochoroidal melanomas that met COMS inclusion criteria for randomisation to enucleation versus radioactiv e plaque but were treated with either helium ions or I-125 brachythera py.Results-At 3 years 36.0% of eyes had 6/12 or better visual acuity. The length of visual retention was most dependent on tumour thickness, tumour location with respect to the optic nerve, fovea, or ciliary bo dy, and patient age. In addition to these factors, the retention of 6/ 12 visual acuity and the time to 6/120 visual acuity were dependent on the preoperative visual acuity. The risk of visual loss was greatest immediately after treatment and decreased with time. The 5 year actuar ial metastatic rate was approximately 13%. Patients at the greatest ri sk of post-radiation visual loss had significantly greater risk of tum our related mortality. Conclusions-Some patients who would have been e ligible for randomisation to either enucleation or radioactive plaque therapy can be irradiated with retention of excellent vision.