摘要
Purpose To evaluate anterior and posterior segment complications and their man agement after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma. De sign Retrospective nonrandomized interventional study. Participants Ninety six patients with a large uveal melanoma according to the Collaborative Ocular Melan oma Study criteria. Methods The patients underwent primary IBT (median dose to t umor apex, 87 Gy). The median tumor height and diameter were 10.7 mm (range, 4.5 -16.8) and 16.5 mm (range, 7.3-25.0) , respectively, and the median follow up time was 3.5 years (range, 0.3-10.4). Cumulative incidence analysis and compet ing risks regression were used to analyze the time to individual complications a nd to identify risk factors. Death and secondary enucleation were analyzed as co mpeting risks. Main outcome measures Cataract, iris neovascularization, glaucoma , maculopathy, optic neuropathy, vitreous hemorrhage, and persistent exudative r etinal detachment (RD). Results The 5-year cumulative incidences of cataract, i ris neovascularization, and glaucoma were 69%(95%confidence interval [CI], 5 7 %-78%), 62%(95%CI, 50%-71%), and 60%(95%CI, 48%-70%), respectively. Posterior segment complications were less common. The 5-year incidences of mac ulopathy and optic neuropathy were 52%(95%CI, 35%-65%) and 46%(95%CI, 30 %-61%), and those of vitreous hemorrhage and persistent RD were 36%(95%CI, 23%-48%) and 25%(95%CI, 15%-36%), respectively. More than 80%of complic ations were diagnosed within 3 years. Cataract was the earliest complication to appear. Except for cataract, the cumulative incidence of dying without developin g a particular complication was 0.24 to 0.62 times that of first developing the complication. Increasing tumor height, which correlates to increasing doses to a djacent tissues, was associated with time to cataract (P=0.017), iris neovascula rization (P=0.087), and RD (P=0.046). Maculopathy and optic neuropathy were asso ciated primarily with distance to the fovea (P=0.015) and optic disc (P=0.015), respectively. Of 57 patients with cataract, 47%underwent cataract extraction, a nd 12%of 51 patients with glaucoma were treated with cyclophotocoagulation. The prevalence s of cataract, elevated intraocular pressure, and RD were 43%, 39%, and 13%, respectively, at 5 years. Conclusions The frequency with which ocular complicati ons develop after IBT is notably influenced by competing risks. Cumulative incid ence and prevalence analysis provide realistic estimates for patient counseling.
Purpose To evaluate anterior and posterior segment complications and their man agement after iodine 125 plaque brachytherapy (IBT) for large uveal melanoma. De sign Retrospective nonrandomized interventional study. Participants Ninety six patients with a large uveal melanoma according to the Collaborative Ocular Melan oma Study criteria. Methods The patients underwent primary IBT (median dose to t umor apex, 87 Gy). The median tumor height and diameter were 10.7 mm (range, 4.5 -16.8) and 16.5 mm (range, 7.3-25.0) , respectively, and the median follow up time was 3.5 years (range, 0.3-10.4). Cumulative incidence analysis and compet ing risks regression were used to analyze the time to individual complications a nd to identify risk factors. Death and secondary enucleation were analyzed as co mpeting risks. Main outcome measures Cataract, iris neovascularization, glaucoma , maculopathy, optic neuropathy, vitreous hemorrhage, and persistent exudative r etinal detachment (RD). Results The 5-year cumulative incidences of cataract, i ris neovascularization, and glaucoma were 69%(95%confidence interval [CI], 5 7 %-78%), 62%(95%CI, 50%-71%), and 60%(95%CI, 48%-70%), respectively. Posterior segment complications were less common. The 5-year incidences of mac ulopathy and optic neuropathy were 52%(95%CI, 35%-65%) and 46%(95%CI, 30 %-61%), and those of vitreous hemorrhage and persistent RD were 36%(95%CI, 23%-48%) and 25%(95%CI, 15%-36%), respectively. More than 80%of complic ations were diagnosed within 3 years. Cataract was the earliest complication to appear. Except for cataract, the cumulative incidence of dying without developin g a particular complication was 0.24 to 0.62 times that of first developing the complication. Increasing tumor height, which correlates to increasing doses to a djacent tissues, was associated with time to cataract (P=0.017), iris neovascula rization (P=0.087), and RD (P=0.046). Maculopathy and optic neuropathy were asso ciated primarily with distance to the fovea (P=0.015) and optic disc (P=0.015), respectively. Of 57 patients with cataract, 47%underwent cataract extraction, a nd 12%of 51 patients with glaucoma were treated with cyclophotocoagulation. The prevalence s of cataract, elevated intraocular pressure, and RD were 43%, 39%, and 13%, respectively, at 5 years. Conclusions The frequency with which ocular complicati ons develop after IBT is notably influenced by competing risks. Cumulative incid ence and prevalence analysis provide realistic estimates for patient counseling.
出处
《世界核心医学期刊文摘（眼科学分册）》
2005年第3期58-59,共2页
Digest of the World Core Medical Journals:Ophthalmology
