Outcomes of cataract surgery in eyes with ocular melanoma treated with iodine-125 brachytherapy

Abstract

To evaluate visual and surgical outcomes of cataract surgery in eyes with a history of iodine-125 (I125) brachytherapy for ocular melanoma. Department of Ophthalmology, David Geffen School of Medicine at UCLA and the Stein Eye Institute, Los Angeles, California, USA. Retrospective case series. Patients with ocular melanoma treated by I125 brachytherapy who subsequently had cataract surgery were evaluated. The recorded data included tumor size, location, preoperative ocular comorbidities, corrected distance visual acuity (CDVA), operative complications, and brachytherapy-related maculopathy before and after surgery. Thirty-two eyes of 32 patients were included. The mean age at the time of cataract surgery was 66.1years. The median follow-up was 53.5months. There were no intraoperative complications. Eighteen eyes (56.3%) had a history of preoperative radiation retinopathy, 10 involving the macula. Between 2weeks and 4 weeks postoperatively, 22 eyes (68.8%) had an improvement in CDVA (≥2 lines). Seven of 10 eyes thatfailed to improve had radiation maculopathy. By the last follow-up examination, 13 eyes (40.6%) had improved CDVA, 9eyes (28.1%) were worse (≥2 lines), and 10 eyes (31.3%) wereunchanged (within ±1 line). Of 15 eyes that lost CDVAgains achieved between 2weeks and 4weeks postoperatively, 9eyes had new-onset or worsening maculopathy. Cataract surgery had no effect on local tumor control or distant metastasis. Cataract surgery after I125 brachytherapy for ocular melanoma improved CDVA in most eyes during the immediate postoperative period. Gains were often lost with further follow-up. Progression of radiation maculopathy was primarily responsible for subsequent visual decline.