Abstract
To report on the clinical characteristics and outcomes for patients with iris melanoma using protontherapy. Retrospective study. One hundred seven patients with iris melanoma from 3 regional ophthalmologic centers. A retrospective study was conducted for iris melanoma patients from 3 regional ophthalmologic centers referred to and treated at a single proton therapy facility between 1996 and2015. At each follow-up visit, examinations included measurement of best-corrected VA, slit-lamp, examination, indirect ophthalmoscopy, and ultrasound biomicroscopy. With a median follow-up of 49.5 months, 5 of 107 patients experienced a local relapse within a median of 36.3 months. The cumulative incidence of relapse was 7.5% at 5 years. All 5 patients showed involvement of the iridocorneal angle (P= 0.056). Diffuse iris melanoma showed a higher risk of relapse (P=0.044). Four patients showed out-of-field relapse and 1 showed angular relapse. Three patients were retreated with proton therapy, whereas 2 other patients, one with T1b disease and another with diffuse T3 disease, underwent secondary enucleation. None of the patients experienced metastases nor died of iris melanoma. Vision improved in 59.4% of patients (n= 60/101). However, cataracts occurred in 57.4% of the 54 patients (n=31) without cataract or implant at diagnosis. Secondary glaucoma was reported in 7.6% of the patients (n=8), uveitis in 4.7% (n= 5), and hyphema in 3.7% (n= 4). All but 5 cases of complications were mild, transient, and not sight limiting after treatment. Five cases of glaucoma, including 1 with uveitis, were severe and associated with visual deterioration. Proton therapy showed efficacy and limited morbidity in iris melanomas.
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