Radiotherapeutic and surgical management of iris melanoma: A review

We compare outcomes following radiotherapeutic and surgical management of iris melanoma. End points included local tumor recurrence, metastases, and common complications. From an initial search that yielded 231 articles, we found 17 relevant studies with 761 eyes. The gender distribution was balanced with a mean age of 52 years. Most studies focused on either proton beam (49.4%) or plaque (31.4%) radiotherapy. Rates of local recurrence (range: 0%-8%) and metastatic development (0%-5%) were favorable following radiotherapy; however, common complications included cataract (36%-73%), glaucoma (3%-92%), and corneal conditions (0%-33%). A unique complication of proton beam radiotherapy was limbal stem cell deficiency (2%-33%). In contrast, iridectomy and comparable procedures showed similar rates of recurrence (0%-8%) and metastases (0% in one study), lower rates of postoperative cataract (0%-33%) and corneal conditions (2.3% in one study), and a greater incidence of photophobia (9%-25%). Following enucleation, one study of mostly advanced eyes demonstrated a higher rate of metastases (14%). Overall, despite a paucity of research in this setting, efficacy and safety outcomes remain favorable. Decision-making for management should be based on tumor size, location, angle seeding, secondary glaucoma, visual potential, and patient preference.