Gallo Beatrice, Hussain Rohan, Al-Jamal Ranaa, Khalid Hagar, Stoker Ian, Hay Gordon, Arora Amit K, Sagoo Mandeep S
Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK
Ocular Oncology Service, Moorfields Eye Hospital NHS Foundation Trust, London, UK.
Br J Ophthalmol. 2025 Jun 23;109(7):809-815. doi: 10.1136/bjo-2023-324686.
BACKGROUND/AIMS: To report the long-term visual outcomes and side effects in patients with small choroidal melanoma (CM) undergoing ruthenium-106 (Ru-106) plaque brachytherapy.
Retrospective, interventional, consecutive series of small CM ≤2.5 mm in height and ≤16 mm in largest basal diameter treated with Ru-106 plaque with a median radiation dose of 100 Gy prescribed to tumour apical height.
310 patients (160 men) with a mean (SD) age of 58.4±14.1 years met the study inclusion criteria. The median follow-up was 57.5 (range 3.4-170.5) months. The mean tumour baseline thickness was 1.9±0.4 (range 0.4-2.5) mm. The mean baseline logarithm of the minimum angle of resolution (logMAR) of best corrected visual acuity (BCVA) was 0.21±0.4 (Snellen equivalent 6/9; range -0.1 to 1.5). Mean final BCVA was ≤0.3 logMAR (Snellen equivalent 6/12) in 161 patients (54.2%), better than 1.0 logMAR (Snellen equivalent 6/60) and <0.3 logMAR in 59 patients (19.9%), and ≥1.0 logMAR in 77 patients (25.9%). Kaplan-Meier estimates of poor final VA (≥1.0 logMAR) were 13.2% at 5 years and 54.5% at 10 years. Early and late complications developed in 20.6% and 42.6% of cases, respectively. Radiation maculopathy was the most frequent late side effect (29% of patients) with Kaplan-Meier rates of 18.2%, 31.7% and 42.1% at 3, 5 and 10 years, respectively. Older age, lipofuscin, proximity to fovea, final tumour elevation and radiation maculopathy predicted visual loss ≥5 Snellen lines.
Despite early and late complications in 20.6% and 42.6% of cases, Ru-106 brachytherapy for small CM allows retention of BCVA ≤0.3 logMAR in half of the eyes.
背景/目的：报告接受钌 - 106（Ru - 106）敷贴近距离放射治疗的小脉络膜黑色素瘤（CM）患者的长期视力预后和副作用。
对高度≤2.5毫米且最大基底直径≤16毫米的小CM患者进行回顾性、介入性、连续系列研究，采用Ru - 106敷贴治疗，规定肿瘤顶端高度的中位放射剂量为100 Gy。
310例患者（160例男性）符合研究纳入标准，平均（标准差）年龄为58.4±14.1岁。中位随访时间为57.5（范围3.4 - 170.5）个月。肿瘤基线平均厚度为1.9±0.4（范围0.4 - 2.5）毫米。最佳矫正视力（BCVA）的最小分辨角对数（logMAR）平均基线值为0.21±0.4（Snellen视力表相当于6/9；范围 - 0.1至1.5）。161例患者（54.2%）的最终BCVA平均≤0.3 logMAR（Snellen视力表相当于6/12），59例患者（19.9%）的视力优于1.0 logMAR（Snellen视力表相当于6/60）且<0.3 logMAR，77例患者（25.9%）的视力≥1.0 logMAR。最终视力差（≥1.0 logMAR）的Kaplan - Meier估计值在5年时为13.2%，10年时为54.5%。早期和晚期并发症分别在20.6%和42.6%的病例中出现。放射性黄斑病变是最常见的晚期副作用（29%的患者），其Kaplan - Meier发生率在3年、5年和10年时分别为18.2%、31.7%和42.1%。年龄较大、存在脂褐质、靠近黄斑中心凹、最终肿瘤隆起和放射性黄斑病变预示视力丧失≥5行Snellen视力表。
尽管分别有20.6%和42.6%的病例出现早期和晚期并发症，但Ru - 106近距离放射治疗小CM可使半数患眼的BCVA保持在≤0.3 logMAR。
