Comparison of primary and secondary enucleation for uveal melanoma

Orbit. 2017 Dec;36(6):422-427. doi: 10.1080/01676830.2017.1337183. Epub 2017 Aug 16.


We investigated operative course and post-operative findings of patients undergoing primary enucleation for uveal melanoma versus those requiring secondary enucleation after brachytherapy. A retrospective chart review was performed with IRB approval on patients receiving treatment for uveal melanoma. Patients with enucleation as initial treatment and patients enucleated after plaque brachytherapy were analyzed for demographic data, operative course, and post-enucleation outcome. Further cause analysis for secondary enucleations was investigated. No significant difference was seen in age, laterality, or gender between the primarily enucleated (n = 54) and secondarily enucleated (n = 34) groups. Greater difficulty with surgery was noted in 28/32 (87.5%) of secondary enucleations compared to 1/54 (1.8%) of primary enucleations (p < 0.0001). Operative time was >2 hours in 3/51 (6%) of primary enucleations (vs. 8 of 32, 25%, p = 0.02). Average implant size was similar in the 2 groups (20.6 mm), however 2/34 (6%) of secondary enucleations required dermis fat grafting. Post-enucleation anophthalmic ptosis occurred after 8/49 (16%) of primary cases (vs. 13/30, 43%, p = 0.02) and prosthetic enophthalmos after none (0%) of primary cases (vs. 5/30, 17%, p = 0.006). Class 2 gene expression profile was found in 6/8 (60%) of eyes enucleated for treatment failure. Secondary enucleation performed after plaque brachytherapy was technically more difficult, and had more anophthalmic socket and eyelid complications compared to primary enucleation for uveal melanoma. Primary enucleation may avoid additional surgery and morbidity in a subset of patients with contraindications to plaque brachytherapy.

Keywords: I-125 brachytherapy; Uveal melanoma; choroidal melanoma; enucleation; plaque brachytherapy.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy*
  • Eye Enucleation*
  • Eye, Artificial
  • Female
  • Humans
  • Iodine Radioisotopes / therapeutic use
  • Male
  • Melanoma / radiotherapy*
  • Melanoma / surgery*
  • Middle Aged
  • Orbital Implants
  • Prosthesis Implantation
  • Retrospective Studies
  • Uveal Neoplasms / radiotherapy*
  • Uveal Neoplasms / surgery*


  • Iodine Radioisotopes

Supplementary concepts

  • Uveal melanoma