Plaque radiotherapy for juxtapapillary choroidal melanoma: treatment complications and visual outcomes in 650 consecutive cases.

IMPORTANCE The treatment of juxtapapillary choroidal melanoma is challenging because of the proximity of the tumor to visually important structures. OBJECTIVE To report the complications of treatment of juxtapapillary choroidal melanoma with plaque radiotherapy. DESIGN, SETTING, AND PARTICIPANTS In this retrospective case series of patients from the Ocular Oncology Service, Wills Eye Hospital, 650 consecutive eyes with juxtapapillary choroidal melanoma (<1 mm to optic disc) treated with plaque radiotherapy from October 1, 1974, through November 30, 2005, were studied. MAIN OUTCOMES AND MEASURES Kaplan-Meier analysis of rates of radiation complications, secondary enucleation, and visual acuity outcomes. RESULTS The 5-year (10-year) rate of nonproliferative retinopathy was 66% (75%); proliferative retinopathy, 24% (32%); maculopathy, 56% (65%); papillopathy, 61% (77%); cataract, 66% (80%); neovascular glaucoma, 15% (22%); vitreous hemorrhage, 35% (42%); and secondary enucleation, 16% (26%). Visual acuity of 20/200 or worse occurred in 54% (87%), and loss of more than 5 lines of Snellen visual acuity was found in 45% (78%). CONCLUSIONS AND RELEVANCE Among this case series, plaque radiotherapy for juxtapapillary choroidal melanoma commonly led to retinopathy and papillopathy, but globe retention was 84% at 5 years. Vision loss should be anticipated in 45% by 5 years. Plaque radiotherapy remains a suitable choice for the treatment of juxtapapillary melanoma with a high globe retention rate.