Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.
Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.
Br J Ophthalmol. 2020 May;104(5):697-702. doi: 10.1136/bjophthalmol-2019-314686. Epub 2019 Aug 13.
To develop a nomogram for prediction of visual acuity outcome following plaque radiotherapy for uveal melanoma.
Retrospective review of uveal melanoma treated with plaque radiotherapy and prophylactic intravitreal bevacizumab injections at 4-month intervals for 2 years duration. Two nomograms for poor visual acuity outcome (Snellen <20/200) were developed based on (1) Clinical risk factors. (2) Or clinical and treatment risk factors.
There were 1131 included cases. The most important clinical risk factors (points for nomogram) for poor visual acuity outcome included subretinal fluid involving four quadrants (100), tumour thickness >4 mm (69), presenting visual acuity ≤20/30 (65), non-Caucasian race (58), tumour shape mushroom, bilobed, or multilobulated (57), and insulin-dependent diabetes (54). Risk of poor visual acuity at 2 years and 4 years increased from 11% and 24% with 40 points to 97% and >99% with 304 points. A second analysis was performed using both clinical and treatment risk factors. The most important factors included presenting visual acuity ≤20/30 (100), tumour largest basal diameter >11 mm (80), radiation dose rate to tumour base ≥164 cGy/hour (78), tumour thickness >4 mm (76), insulin-dependent diabetes (75) and abnormal foveolar status by optical coherence tomography at presentation (72). Risk of poor visual acuity at 2 years and 4 years increased from 6% and 14% with 56 points to 88% and 99% with 496 points.
A nomogram using clinical or treatment risk factors can predict visual acuity outcome following plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma and is available online at https://fighteyecancer.com/nomograms/.
建立预测眼黑色素瘤瘤体放射性敷贴治疗后视力结果的列线图。
回顾性分析接受放射性敷贴治疗并预防性玻璃体内注射贝伐单抗（每 4 个月 1 次，共 2 年）的眼黑色素瘤患者。基于（1）临床危险因素；（2）或临床和治疗危险因素，建立 2 个预测视力不良结局（Snellen 视力表<20/200）的列线图。
共纳入 1131 例患者。视力不良结局的最重要临床危险因素（列线图积分）包括：累及四个象限的视网膜下积液（100）、肿瘤厚度>4mm（69）、初始视力≤20/30（65）、非白种人（58）、肿瘤形状蘑菇状、双叶状或多叶状（57）和胰岛素依赖型糖尿病（54）。2 年和 4 年时视力不良的风险从 40 分的 11%和 24%增加到 304 分的 97%和>99%。对临床和治疗危险因素进行了二次分析。最重要的因素包括初始视力≤20/30（100）、肿瘤最大基底直径>11mm（80）、肿瘤基底的辐射剂量率≥164cGy/h（78）、肿瘤厚度>4mm（76）、胰岛素依赖型糖尿病（75）和初始时光学相干断层扫描显示黄斑区异常（72）。2 年和 4 年时视力不良的风险从 56 分的 6%和 14%增加到 496 分的 88%和 99%。
使用临床或治疗危险因素的列线图可以预测眼黑色素瘤瘤体放射性敷贴治疗和预防性玻璃体内注射贝伐单抗后的视力结果，可在 https://fighteyecancer.com/nomograms/ 在线获取。
