Treatment of macular oedema following proton beam therapy for choroidal melanoma with dexamethasone 700µg intravitreal implant

Abstract

AbstractPurpose To report the treatment of radiation macular edema following proton beam therapy for choroidal melanoma with dexamethasone 700µg intravitreal implant.Methods Retrospective cases reportResults Five patients were treated with a single injection of intravitreal dexamethasone 700 µg. These patients presented with an uveal melanoma (mean thickness: 4.44 mm, mean highest diameter: 11.14mm) located at 2.58mm (range 0 to 3.5mm) from the macula. Patients were treated with proton beam irradiation (60 Gy cobalt relative biological effectiveness in 4 fractions) 26.75 months (range 16‐43 months) before the occurrence of radiation macular edema. The intravitreal injection of dexamethasone700 µg was performed 5.5 months (1‐14) after the diagnosis of macular edema. Best corrected visual acuity improved for 4 patients (5; 7; 9 and 10 letters), and remained unchanged for 1 patient, over a 5 months follow‐up period. Central retinal thickness decreased for 3 patients (231; 151 and 97 µm) and remained unchanged for 2 patients. Intraocular pressure increased for 1 patient (IOP>25 mmHg at month 3). No other ocular or systemic side effects were noted.Conclusion Radiation macular edema is a common vision threatening complication following proton beam therapy. The available therapeutic options are limited. Intravitreal injections of dexamethasone implant can be of benefit in selected cases.