Lyons Lance J, Hinds Ethan D, Chexal Sarada, Berger Brian
Ophthalmology, University of Texas Medical Branch, Galveston, USA.
Ophthalmology, Retina Consultants of Austin, Austin, USA.
Cureus. 2019 Jul 29;11(7):e5270. doi: 10.7759/cureus.5270.
Purpose Silicone oil a burgeoning adjuvant in the treatment of uveal melanoma where it is used for tissue protection during I-125 brachytherapy. While risk factors in the development of radiation retinopathy (RR) have been identified, treatment modulation for high-risk patients has largely been overlooked. We seek to expand the literature on this subject by reporting outcomes of I-125 brachytherapy with silicone oil in a high-risk population in the community setting. Methods Five patients with uveal melanoma and at least one risk factor for RR development underwent iodine-125 (I-125) plaque brachytherapy with concurrent pars plana vitrectomy (PPV), silicone oil administration, and fine needle aspiration biopsy (FNAB). Plaque and silicone oil removal were performed after seven days. Minimum follow-up was 12 months. Results Follow-up ranged from 12 to 56 months. Macular radiation doses ranged from 12.55 to 141.5 Gy; the two eyes with the largest doses developed RR at 34 and 15 months as well as neovascular glaucoma (NVG). Surgical complications included one rhegmatogenous retinal detachment (RD) and an intra-operative vitreous hemorrhage with post-operative hyphema requiring additional intervention. Conclusion RR may be attenuated by silicone oil administration in patients with some risk factors. In tumors farther from the macula, this benefit is more readily apparent. Tumors located more posteriorly may not benefit from silicone oil administration considering postoperative complications and operating time. Patient demographics, tumor characteristics, and anticipated macular radiation dosage may help determine which patients can benefit from silicone oil and identify patient risks for adverse outcomes.
目的 硅油是治疗葡萄膜黑色素瘤中一种新兴的辅助剂，在碘-125近距离放射治疗期间用于组织保护。虽然已经确定了放射性视网膜病变（RR）发生的风险因素，但高危患者的治疗调整在很大程度上被忽视了。我们试图通过报告在社区环境中高危人群中使用硅油进行碘-125近距离放射治疗的结果来扩充关于这一主题的文献。方法 5例患有葡萄膜黑色素瘤且至少有一个RR发生风险因素的患者接受了碘-125（I-125）敷贴近距离放射治疗，同时进行了玻璃体切除术（PPV）、硅油注入和细针穿刺活检（FNAB）。7天后进行敷贴和硅油取出。最短随访时间为12个月。结果 随访时间为12至56个月。黄斑区辐射剂量范围为12.55至141.5 Gy；辐射剂量最大的两只眼睛分别在34个月和15个月时发生了RR以及新生血管性青光眼（NVG）。手术并发症包括1例孔源性视网膜脱离（RD）和1例术中玻璃体出血伴术后前房积血，需要额外干预。结论 对于有一些风险因素的患者，硅油注入可能会减轻RR。在离黄斑较远的肿瘤中，这种益处更明显。考虑到术后并发症和手术时间，位于更靠后的肿瘤可能无法从硅油注入中获益。患者人口统计学特征、肿瘤特征和预期的黄斑区辐射剂量可能有助于确定哪些患者可以从硅油中获益，并识别患者出现不良结局的风险。
