Incidence of radiation retinopathy after high-dosage single-fraction gamma knife radiosurgery for choroidal melanoma

Ophthalmology. 2002 May;109(5):909-13. doi: 10.1016/s0161-6420(02)01011-4.

Abstract

Objective: To investigate the incidence and clinical findings of radiation retinopathy after single-fraction high-dose gamma knife radiosurgery for choroidal melanoma.

Design: Retrospective noncomparative interventional case series.

Participants: Thirty-two patients with choroidal melanoma.

Methods: Review of charts, color fundus photographs, and fluorescein angiograms of 32 choroidal melanoma patients after radiosurgery. All patients were treated with the Leksell gamma knife in one fraction with a marginal dose between 40 and 80 Gy (median, 50 Gy) and were followed for at least 24 months (or until enucleation because of complications secondary to radiation).

Main outcome measures: Any clinical feature of radiation retinopathy and neovascular glaucoma.

Results: During a mean follow-up of 38 months (range, 6-81 months) we found radiation retinopathy in 84% of our patients. The most common findings in these patients were intraretinal hemorrhages with an incidence of 70%, macular edema and capillary nonperfusion in 63%, and hard exudates in 52% of the patients. Less common were microaneurysms in 30% and retinal neovascularization in 22%. The time of onset of the various radiation-associated retinal findings ranged between 1 and 22 months. Forty-seven percent of all patients developed neovascular glaucoma. In our study there was no correlation between radiation dosage applied and clinical findings.

Conclusions: Single-fraction high-dose Leksell gamma knife radiosurgery of choroidal melanomas with a median marginal dose of 50 Gy is highly associated with early radiation retinopathy and with neovascular glaucoma.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Choroid Neoplasms / surgery*
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Glaucoma, Neovascular / epidemiology
  • Glaucoma, Neovascular / etiology
  • Humans
  • Incidence
  • Male
  • Melanoma / surgery*
  • Middle Aged
  • Radiation Injuries / epidemiology
  • Radiation Injuries / etiology*
  • Radiosurgery / adverse effects*
  • Retina / radiation effects*
  • Retinal Diseases / epidemiology
  • Retinal Diseases / etiology*
  • Retrospective Studies