Department of Ophthalmology, University Hospital of Essen, Essen, Germany.
Department of Radiotherapy, University Hospital of Essen, Essen, Germany.
Clin Exp Ophthalmol. 2021 May;49(4):357-367. doi: 10.1111/ceo.13928. Epub 2021 May 4.
Radiation-induced scleral necrosis (RISN) is a rare, but a serious complication of brachytherapy for uveal melanoma. We aimed at analysing the incidence, timing and risk factors associated with development of RISN in a large institutional series.
All consecutive cases with brachytherapy for uveal melanoma treated by the Departments of Ophthalmology and Radiotherapy at University Hospital Essen between 1999 and 2016 were eligible. Development of RISN during the post-treatment follow-up was recorded. A 1:2 propensity score matched case-control study was performed for the evaluation of the prognostic value of different tumour- and treatment-associated parameters.
RISN was documented in 115 (2.9%) of 3960 patients with uveal melanoma included in the final analysis, and occurred at the mean 30.3 months (range: 1.26-226 months) after brachytherapy. In the whole cohort, younger age (p = 0.042), plaque type (p = 0.001) and ciliary body involvement (p < 0.0001) were independently associated with the RISN occurrence. In the case-control study, multivariable weighted proportional hazard analysis discovered the association of the following additional tumour- and treatment-associated characteristics with RISN: posterior tumour margin anterior to equatorial region (p = 0.0003), extraocular tumour extension (p = <0.0001), scleral contact dose (p = <0.0001), conjunctival dehiscence after therapy (p = 0.0001), disinsertion of the superior rectus muscle (p = 0.001) and the glaucoma medication (p = 0.014).
Our study confirms RISN as a rare complication, which might occur even years later after the brachytherapy for uveal melanoma. Alongside with scleral dose five other tumour and therapy related factors predict the risk of RISN after brachytherapy for uveal melanoma were established.
放射性巩膜坏死（RISN）是眼葡萄膜黑色素瘤近距离放射治疗的一种罕见但严重的并发症。我们旨在通过分析在大型机构系列中发生 RISN 的发生率、时间和相关风险因素。
1999 年至 2016 年间，埃森大学医院眼科和放射治疗科治疗的所有连续眼葡萄膜黑色素瘤接受近距离放射治疗的患者均符合条件。记录治疗后随访期间 RISN 的发展情况。进行了 1:2 倾向评分匹配病例对照研究，以评估不同肿瘤和治疗相关参数的预后价值。
3960 例眼葡萄膜黑色素瘤患者中，最终分析纳入 115 例（2.9%）患者发生 RISN，发生于近距离放射治疗后平均 30.3 个月（范围：1.26-226 个月）。在整个队列中，年龄较小（p=0.042）、斑块型（p=0.001）和睫状体受累（p<0.0001）与 RISN 发生独立相关。在病例对照研究中，多变量加权比例风险分析发现以下肿瘤和治疗相关特征与 RISN 相关：肿瘤后缘位于赤道区域前（p=0.0003）、眼外肿瘤扩展（p<0.0001）、巩膜接触剂量（p<0.0001）、治疗后结膜裂开（p=0.0001）、上直肌脱位（p=0.001）和青光眼药物治疗（p=0.014）。
我们的研究证实 RISN 是一种罕见的并发症，即使在眼葡萄膜黑色素瘤近距离放射治疗后数年也可能发生。除了巩膜剂量外，还有另外五个与肿瘤和治疗相关的因素预测了眼葡萄膜黑色素瘤近距离放射治疗后 RISN 的风险。
