# Vitreoretinal Surgery for Intraocular Complications Following Radiotherapy Treatment of Uveal Melanoma

## TL;DR

This study examines vitreoretinal surgery outcomes in patients with uveal melanoma after radiotherapy, finding that such patients often experience worse vision and tumor control.

## Contribution

The study provides new insights into the outcomes of vitrectomy following radiotherapy for uveal melanoma, emphasizing the need for multidisciplinary care.

## Key findings

- Patients who underwent vitrectomy had higher rates of enucleation, metastasis, and visual decline compared to those without surgery.
- Proton-beam radiotherapy was associated with more vitreoretinal complications than plaque brachytherapy.
- Vitreoretinal surgery may help preserve the eye in cases where enucleation would otherwise be necessary.

## Abstract

Uveal melanoma is a rare eye cancer that is commonly treated with radiotherapy, as it provides an opportunity for treatment while allowing patients to keep their eye rather than having it surgically removed. This treatment can, however, lead to complications needing surgery, often a procedure called a vitrectomy. In this study, we analysed patients who underwent vitrectomy after radiotherapy to better understand future visual quality and the degree of tumour control. We found that these patients often had aggressive cancers and were more likely to suffer a decline in vision, exhibit a lack of tumour control, and more commonly require removal of the affected eye. The findings highlight the importance of collaborative management between oncologists and eye surgeons. This data allows both doctors and patient to understand the possible risks before starting radiotherapy treatment.

(1) Background: Globe-sparing radiotherapy is widely utilised in the treatment of uveal melanoma, but often results in complications requiring vitreoretinal intervention. The outcomes of secondary vitrectomy remain unclear. A multidisciplinary approach involving vitreoretinal and ocular oncology specialists is essential to managing complications. (2) Methods: We reviewed 1794 patients treated with radiotherapy for uveal melanoma between 2012 and 2022. In total, 70 patients underwent secondary vitrectomy after primary radiotherapy treatment. The outcomes included overall tumour control and visual outcome. (3) Results: Complications requiring vitrectomy were more common after proton-beam radiotherapy than plaque brachytherapy (5.4% versus 3.0%). Common indications included vitreous haemorrhage (39%) and retinal detachment/toxic tumour syndrome (31%). The affected tumours were larger, more often ciliary body in origin, and associated with a worse prognosis. Vitrectomy patients had higher rates of enucleation (9% versus 3%), metastasis (16% versus 6%), and visual decline (average 0.60 LogMAR), with limited visual improvement (≥3-line gain in 13%). Proton-beam patients had worse outcomes than plaque brachytherapy patients. (4) Conclusions: Vitreoretinal complications after uveal melanoma radiotherapy are rare, but timely treatment by those with experience may enable patients to keep their eye in situations where enucleation would be the only alternative. Patients and clinicians must understand the risks of complications to make informed decisions about treatment plans, with vitreoretinal surgeons and ocular oncologists key to outcomes.