Iodine 125 plaque brachytherapy versus transscleral tumor resection in the treatment of large uveal melanomas

Purpose: To compare iodine 125 (I-125) plaque brachytherapy with transscleral tumor resection (TTR) of large uveal melanomas. Design: Retrospective, nonrandomized, comparative, interventional study. Participants: Two hundred thirty-seven patients with large uveal melanomas. Intervention: One hundred fifty-two uveal melanoma patients were treated with I-125 brachytherapy and 85 patients were treated with TTR. Patients were matched according to age, tumor size, and tumor location. Eighteen patients treated with I-125 brachytherapy and 36 patients treated with TTR were eligible for the matched group comparison. The mean patient age was 40.5 years, mean tumor height was 9.4 mm, and mean largest tumor diameter was 14.5 mm. The mean distance of the posterior tumor margin to the optic disc was 9.9 mm and to the fovea was 9.4 mm. The mean follow-up was, 27.1 months. Main Outcome Measures: Final visual acuity, incidence of secondary glaucoma, secondary enucleation, and metastatic rates. Results: Visual acuity of 20/200 or better was retained in 61.1 % of patients after TTR and 5.6% of patients after I-125 brachytherapy (P < 0.0009). The incidence of secondary glaucoma was higher after I-125 brachytherapy (33.3%) than after TTR (5.6%; P = 0.03). No difference was found with respect to eye retention (P = 0.3) and mortality rates (P = 0.9). Conclusions: Patients with large melanomas eligible for TTR retain a better visual function and have a lower incidence of secondary glaucoma than those treated by I-125 brachytherapy. (C) 2002 by the American Academy of Ophthalmology.