Outcomes of Persistent Exudative Retinal Detachments Following Proton Beam Irradiation for Choroidal Melanoma

To assess the outcomes of persistent large exudative retinal detachments (ERD) following proton beam irradiation (PBI) for choroidal melanoma.

A retrospective study evaluated patients with a diagnosis of ERD in the setting of choroidal melanoma treated with PBI at a single academic tertiary center. Inclusion criteria were the presence of an ERD for at least 3 clock hours at the time of melanoma diagnosis. Data collected included tumor features, management, and visual and anatomic outcomes.

The study comprised 50 eyes of 50 patients with a median age of 51.7 years (range 19.3 - 78.5 years) and a median follow-up of 35.1 months (range 6.6 - 247.9 months). Thirty-five patients were treated with conservative management, which included observation or intraocular steroids, and 15 patients underwent surgical management with pars plana vitrectomy, drainage of subretinal fluid, endolaser, and silicone oil placement for persistent ERD at a median duration of 7.5 months (range 1.3-117.6 months) following PBI. The study found no difference in outcomes of final visual acuity, radiation retinopathy, neovascular glaucoma, and enucleation between conservative and surgical management. Refractory ERD was found to be a significant risk factor for the development of neovascular glaucoma.

Choroidal melanoma with a large ERD can be successfully treated with conservative or surgical management after proton beam radiation therapy.