Scleral necrosis after radiation therapy for uveal melanomas: report of 23 cases

Abstract

Aims

To describe the evolution and management over time of scleral necrosis as a complication after radiation therapy for uveal melanomas.

Design

Retrospective nonrandomized case series.

Methods

Twenty-three patients (12 male, 11 female; median age 56.4 years; range, 30–73 years) treated with a single plaque therapy (cobalt-60 (Co⁶⁰) or iodine-125 (I¹²⁵) (1.5% of treated patients) or proton beam radiotherapy (0.45% of treated patients) for choroidal or ciliary body melanoma, presenting scleral necrosis as a post-radiation complication, were studied. Tumor characteristics, intraocular pressure, location and size of scleral necrosis were recorded during visits after radiation therapy.

Results

The median maximal tumour base and thickness at diagnosis were 14.6 ± 4.4 mm and 7.2 ± 2.3 mm respectively. Median radiation dose to tumor base and tumor apex was 223 Gy and 88.3 Gy respectively. The mean time of scleral necrosis onset after radiation therapy was 70.4 months (range 11–257 months); the mean scleral necrosis diameter at its onset was 4.4 mm (range 1–10 mm). Out of 23 affected eyes, 17 presented a stability of scleral necrosis; in three cases there was partial regression of scleral necrosis; in two cases there was a progressive extension of scleral necrosis until a pre-perforation stade. In two cases, a secondary enucleation was necessary due to a severe neovascular glaucoma.

Conclusions

Scleral necrosis is a rare complication of radiotherapy for uveal melanomas. Relapse with extrascleral extension of the primary tumor has to be ruled out in order to avoid unnecessary enuclations. In most patients, the scleral necrosis remains stable and does not need any further treatment.