Ipsilateral Eyelid Disorders Following Ocular Brachytherapy

Area of Science:

• Ophthalmology
• Oncology
• Radiation Therapy

Background:

• Episcleral brachytherapy is a standard treatment for uveal melanoma, but its long-term complications typically focus on intraocular structures.
• Eyelid complications after brachytherapy plaque surgery are infrequently reported.
• This study investigates the prevalence, characteristics, and risk factors of acquired ipsilateral eyelid disorders (IEDs) following ocular brachytherapy.

Purpose of the Study:

• To determine the incidence and nature of eyelid disorders after episcleral brachytherapy.
• To identify risk factors associated with the development of these eyelid complications.
• To raise awareness of underrecognized eyelid sequelae following uveal melanoma treatment.

Main Methods:

• Retrospective cohort study of 191 patients treated with episcleral brachytherapy (2009-2023).
• Data collection included patient demographics, tumor details, plaque specifics, surgical procedures, and postoperative eyelid conditions.
• Statistical analysis, including multivariate logistic regression, was used to identify associations between treatment parameters and IEDs.

Main Results:

• 20.9% of patients developed IEDs, most commonly affecting the upper eyelid.
• Ptosis was the predominant complication (87.5% of IEDs), significantly associated with Iodine-125 use and anterior tumor location.
• Iodine-125 (OR 5.38) and anterior tumor location (OR 2.40) were independent predictors of postoperative ptosis.

Conclusions:

• Acquired upper eyelid ptosis is a common, yet often overlooked, complication of episcleral brachytherapy for uveal melanoma.
• Risk factors include the use of Iodine-125 and the tumor's anterior location.
• Ophthalmologists should be aware of these potential eyelid issues and consider referrals to oculoplastic specialists.