Grajewski Luise, Kneifel Christiane, Wösle Markus, Ciernik Ilja F, Krause Lothar
Department of Ophthalmology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany.
Department of Radiation Oncology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane, Dessau, Germany.
Int Ophthalmol. 2025 Jan 11;45(1):23. doi: 10.1007/s10792-024-03381-6.
Uveal melanoma (UM) is the most common primary ocular malignancy. The size and location of the tumor are decisive for brachytherapy with the β-emitting ruthenium-106 (Ru-106) plaque. The treatment of juxtapapillary and juxtafoveolar UM may be challenging because of the proximity or involvement of the macula and optic nerve and high recurrence rates.
Central UMs were defined as lesions up to 5 mm off the optic disc or fovea radius of 5 mm. Between January 2011 and July 2020, we treated 56 patients with Ru-106-brachytherapy. The clinical outcomes for recurrence, visual acuity, and radiation-related toxicity were assessed. The follow-up was 66 (6-136) months.
Of the 56 patients (56 eyes), 8 (14%) suffered from local recurrence. Six relapsing UM in 19 (32%) patients were located close to the optic disc, and two patients had UM close to the macula (2/37, 5%) (p > 0.05). The overall eye-preservation rate was 89%. The pretreatment visual acuity (VA) was 0.45 and reduced to 0.26 after brachytherapy. Radiation retinopathy or optic neuropathy was detected in 7 (13%) patients and radiation maculopathy in 10 (17.9%). Six patients (11%) underwent enucleation for recurrence or radiation-induced ophthalmopathy.
Central UMs are challenging to treat. UMs should be categorized as lesions laterally or medially to the fovea because of different long-term control rates. Localization near the optic disc requires thoughtful management.
葡萄膜黑色素瘤（UM）是最常见的原发性眼部恶性肿瘤。肿瘤的大小和位置对于使用发射β射线的钌-106（Ru-106）斑块进行近距离放射治疗至关重要。由于黄斑和视神经的接近或受累以及高复发率，视乳头旁和黄斑旁UM的治疗可能具有挑战性。
中心性UM被定义为距视盘或黄斑半径5毫米以内的病变。2011年1月至2020年7月期间，我们对56例患者进行了Ru-106近距离放射治疗。评估了复发、视力和放射相关毒性的临床结果。随访时间为66（6-136）个月。
56例患者（56只眼）中，8例（14%）发生局部复发。19例（32%）患者中有6例复发性UM位于视盘附近，2例患者的UM靠近黄斑（2/37，5%）（p>0.05）。总体保眼率为89%。治疗前视力（VA）为0.45，近距离放射治疗后降至0.26。7例（组）患者（13%）检测到放射性视网膜病变或视神经病变，10例（17.9%）检测到放射性黄斑病变。6例患者（11%）因复发或放射性眼病而接受眼球摘除术。
中心性UM治疗具有挑战性。由于长期控制率不同，UM应分类为位于黄斑外侧或内侧的病变。视盘附近的定位需要谨慎处理。
