This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on ISI (2)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Ocular/ Adnexal Tumors  • Retinal/ Chorioretinal Disorders  • Enucleation  • Alert me on articles by topic  Social Bookmarking   What's this?

Robert B. Avery, MD, PhD; Marie Diener-West, PhD; Sandra M. Reynolds, MAS; Hans E. Grossniklaus, MD, MBA; W. Richard Green, MD; Daniel M. Albert, MD, MS

Arch Ophthalmol. 2008;126(2):207-212.

Objective  To describe the histopathologic findings in eyes with uveal melanoma that had secondary enucleation after failed brachytherapy plaque treatment.

Methods  Histopathologic findings in eyes that had secondary enucleation after plaque radiation therapy in the Collaborative Ocular Melanoma Study (COMS) were reported on a standardized data form. The findings were compared with eyes that had primary enucleation for uveal melanoma.

Results  Seventy-five eyes that had secondary enucleation were studied. Compared with primary enucleations, tumors in the irradiated eyes had lower mitotic activity, a smaller proportion of histologically intact tumor, more inflammation, more fibrosis, and more vascular damage within the tumor. In addition, compared with primary enucleations, eyes previously irradiated had a higher frequency of retinal invasion by the tumor and greater damage to the retinal vasculature, consistent with radiation retinopathy; neovascularization of the iris; and vitreous hemorrhage. Tumor growth or extrascleral extension was confirmed histopathologically in 25 of 42 eyes (60%) enucleated because of a reported failure of local control.

Conclusions  Eyes with secondary enucleation after brachytherapy differ histopathologically from eyes with primary enucleation for uveal melanoma. These histopathologic differences may be due to the effects of radiation, tissue conditions related to plaque failure, and, in some cases, tumor growth. In 40% of eyes enucleated because of suspected failure of local control, increased tumor size could not be histologically confirmed.

Author Affiliations: Division of Ophthalmology, University of New Mexico, Albuquerque (Dr Avery); Departments of Biostatistics (Dr Diener-West) and Ophthalmology (Drs Diener-West and Green and Ms Reynolds), Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology, Emory University, Atlanta, Georgia (Dr Grossniklaus); and Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison (Dr Albert).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?