Glaucoma may develop after plaque radiotherapy for iris melanoma
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Patients with iris melanoma treated with plaque radiotherapy were more likely to develop post-management glaucoma than when other conservative treatments were used, according to a speaker.
“Post-management glaucoma was found with lower frequency amongst those who had local resection and was more commonly found in those who had plaque radiotherapy,” Aakriti G. Shukla, MD, said at the virtual American Academy of Ophthalmology annual meeting.
In a retrospective review of consecutive patients with primary iris melanoma seen at the Ocular Oncology Service at Wills Eye Hospital from 1970 to 2016 who underwent observation, local resection or plaque radiotherapy, 75 of 271 eyes developed post-management glaucoma.
Of 166 eyes that underwent local resection, 37 developed post-management glaucoma vs. 129 that did not, a statistically significant difference (P = .01). Plaque radiotherapy was associated with a more than three times greater risk for post-management glaucoma compared with local resection (P < .001).
“In this presentation, we focus on post-management glaucoma, which we have defined as IOP greater than 22 mm Hg due to treatment factors that led to glaucoma and melanoma-related glaucoma on presentation,” Shukla said.
Post-management glaucoma is associated with older age. The mean age of patients with post-management glaucoma was 56.6 years vs. 49.7 years for patients with no post-management glaucoma. The proportion of women in the post-management glaucoma group (42 of 75, 56%) was statistically significantly greater than the proportion of women in the non-glaucoma group (84 of 196, 43%) (P = .05). All study participants were identified as Caucasian.
“Post-management was associated with lower Snellen visual acuity, counting fingers in the post-management glaucoma group vs. 20/70 in the non-glaucoma group, and higher frequency of three lines or more of vision loss,” Shukla said.
Post-management glaucoma was also associated with a higher frequency of tumor recurrence, with 20% in the glaucoma group seeing recurrence vs. 7% in the non-glaucoma group. There was no significant difference in metastasis and death between the groups, Shukla said.
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Shukla AG. Iris melanoma with post-management glaucoma: A study of 271 patients at a single ocular oncology center. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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