Table 3.
Summary of case-control studies of partial lamellar sclerouvectomy for uveal melanoma.
| Author | Treatment | Patients, n. | Diameter, mm |
Thickness, mm | Follow-Up, mean | Survival | Enucleation | Recurrence | VA Pre-Treatment |
VA Post-Treatment |
BT |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Foulds et al., 1987 (Matched for diameter) [13] |
PLSU (Laser or BT adjuvant not all) | 157 | 13.3 ± 4 mm maximum diameter | Overall 5 years 79% (26/33) <15 mm diameter 5-year mortality 11.6% and >16 mm 57% |
22% | 17% residual or recurrent 2% orbital recurrent |
65% useful vision (between 6/6 and CF) |
VH: 23% RD: 25% CT:15–61% |
|||
| Enucleation | 241 | 13.3 ± 4 mm maximum diameter | 5 years: 47% (89/188) 5-year mortality by diameter <15 mm: 30% >16 mm: 65% |
100% | 0 | 0 | - | ||||
| Augsburger et al., 1990 [14] | PLSU (No BT adjuvant) |
30 | 9.8 | 5.7 | 3.0 y | 3/30 KM 5 years: 85.2% |
20/30 | 20/200 <20/200 at 5 years 66.8% |
Significantly worse vision in PLSU | ||
| BT Co60 | 30 | 10.7 | 5.8 | 6.0 y | 7/30 KM 5 years: 81.8% |
20/25 | 20/40 <20/200 at 5 years 44.4% (p = 0.0008) |
No difference in mortality | |||
| Bechrakis et al., 2002 [15] | PLSU (BT Ruth-106 adj., not all) | 85 (36 matched) | 14.4 (±3.0) | 9.5 (±2.1) | 24.0 m (±16) | 5.6% NO KM curves |
11.1% | Persistent tumour: 13.9% Recurrence: 8.3% |
≥20/200 retained in 61.1% | Cataract: 44.4% Additional VR surgery: 44.4% Peripheral cryo: 5.6% PRP:2.8% Neovascular glaucoma 5.6% Cyclocrio: 0% |
|
| BT I-125 | 152 (80 matched) | 14.6 (±2.4) | 9.0 (±1.1) | 33.0 m (±19) | 11.1% NO KM curves |
5.6% | Persisting tumour 5.6% Recurrence 5.6% |
20/200 or better was retained in 5.6% | Cataract: 28% PRP: 66.6% Peripheral cryo: 11.1% Neovasc glaucoma 33.3% Cyclocryo: 5.6% |
||
| Kivela et al., 2003 [16] two centres only, one treatment in each centre (UK/ Finland retrospective study) |
PLSU (BT Ruth106 adjuvant not all) | 49 | less than 12 mm for 13 pairs (26%), between 12 and 14 mm for 17 pairs (35%), and 14 mm or more for 19 pairs (39%). | Median 8.0 IQR (7.0–9.0) | 18.3% (9 pts mets) 8 year all-cause and melanoma-specific survivals did not differ |
Not reported Almost 32.6% (16 recurrences) |
16 pts (32.6%) (14 pts, no adjuvant RT) 2 pts also developed an extrascleral recurrence |
20/40 or better for 17 (35%) matched pairs, between 20/50 and 20/200 for 25 pairs (51%), and worse than 20/200 for 7 pairs (14% | The risk of losing 20/60 vision did not differ statistically after TSR and IBT The risk of losing 20/200 vision was significantly higher after IBT than after TSR |
Higher risk of cataract, vitreous hemorrhage, maculopathy after IBT Rubeosis, neovascular glaucoma, and optic neuropathy developed only after IBT |
|
| BT I-125 | 49 | idem | Median 7.8 IQR (7.0–9.3) | 22.4% (11 pts mets) | 6.1% (3 pts) |
6.1% (3 pts) |
Significantly Higher risk of local recurrence after TSR The risk of retinal detachment did not differ between TSR and IBT |
||||
| Puusaari et al., 2007 [11] two centres only, one treatment in each centre (UK/ Finland retrospective study) |
PLSU (BT Ruth106 adjuvant not all) |
33 | Median 12.5 mm (range 9.8–16) | Median 11.0 mm (range, 8.0–14) | 2.3 years | Not reported | 24.2% (8 pts) 5-year incidence 28% (95% CI, 7–40) |
27% (9 pts) 5-year incidence of local recurrence 41% (95% CI, 17–63) after TSR. 37% vs. 46% adjuvant irradiation vs. none. |
33% (11 pts) in the TSR arm and 33% (18 pts) in the IBT arm had visual acuity better than 20/70 | The mean visual acuity after TSR was 20/320 to 20/640 throughout the first 5 years and approximately one line better than the mean visual acuity after IBT, which varied between 20/640 and 20/1250 Cumulative incidence of loss of visual acuity 20/400 was 53% at one and 60% at 2 and 3 years |
Adj. ruth BT. At 5 years, cataract in 91% after TSR and 78% after IBT. At 5 years, maculopathy in 63% after TSR and 43% after IBT. RD 5-year cumulative incidence 43%. decreased rapidly to <20% after TSR. Vitreous bleeding in 69% within 6 months of surgery but no new bleeding after this period. Glaucoma and optic neuropathy were rare after TSR |
| BT I-125 | 54 | 14.0 mm (range, 7.3–16) | median, 10.6 mm; range, 8.2–13.3 | 5.3 years | Not reported | 5 pts 5-year incidence 10% (95% CI 4–20) |
3 pts 5-year incidence of local recurrence: 7% (95% CI, 2–17) after IBT |
Cumulative incidence of loss of visual acuity 20/400 were 60% (95% CI, 44–73), 75% (95% CI, 59–86) and 91% (95% CI, 76–97) | Iris NV and glaucoma only in IBT optic neuropathy 5 years was 7% TSR and 58% in IBT RD exudative 5-year cumulative incidence 27% vitreous haemorrhage 5-year cumulative incidence of was 39% after IBT Cataract, maculopathy, RD, and vitreous haemorrhage were common after either treatment. |
||
| Caminal et al., 2016 [17] Resection without hypotensive anaesthesia |
PLSU (adjvant BT in some but not all) |
19 | Median 14.7 (11.0–20.0) |
Median 11 (4.0–12.0) |
50.9 months (9.6–102.5 |
15.8% (3 mets) 10.5% (2 deaths) K-M at 5 years 79.1% without mets K-M DSS: 84% at 5 y |
21.1% (5 pts) KM at 5 ears 70.9% maintain the eye |
10.5% (3 pts) K-M at 5 years 82.5% free Recurrences in pts no adjuvant BT |
20/200 (20/20.000–20/20) | 20/34 (20/20.000–20/20) ≥20/200 or better: 53.3% |
Better preservation of VA. Most common complications: rhegmatogenous RD (21.1%) and ocular hypertension (21.1%). |
| I-125 BT | 53 | Median 15.5 (8.0–20.0) |
Median 9 (6.0–11.0) |
55.9 months (9.6–107.8) |
26.4% (14 mets) 9.4% (5 deaths) K-M at 5 years: 74.2% without mets K-M at 5 years DSS: 93.2% |
9.4% (4 pts) KM at 5 y 89.8% |
5.7% (2 pts) K-M at 5 years 94.1% free |
20/40 (20/20.000–20/20) | 20/20.000 (20/200.000–20/25) ≥20/200: 31.2% |
Most common complications: radiation-induced retinopathy (45.3%), neovascular glaucoma (28.3%) and macular oedema. (24.5%) |
Abbreviations: PLSU: partial lamellar sclerouvectomy; CI, confidence interval; DSS, disease-specific survival; PRP: Panretinal photocoagulation; BT: Brachytherapy; VR surgery: vitreoretinal surgery; KM: Kaplan-Meier; CF: counting fingers; RD: retinal detachment; mets, metastasis; IBT, iodine brachytherapy; TSR, transscleral resection.