Meta-analysis on the utility of radiotherapy for the treatment of Ocular Melanoma

Introduction: Uveal melanoma is the most common intraocular tumor in the adult population. It can affect any part of the uveal tract: the iris, ciliary body, and choroid. Historically, enucleation has been the mainstay of treatment for primary melanoma. In the last decade, however, radiotherapy has acquired an increasingly important role and has now become our first-line modality. However, it is still widely debated what is the most effective radiotherapy technique for this tumor. Purpose to perform a literature review on the utility of radiotherapy for primary ocular melanoma and determine the most effective radiotherapy technique Materials and Methods: We included all systematic and narrative reviews on the topic, published between September 2007 and November 2017 on PubMed and SCOPUS. Two independent reviewers assessed the eligibility criteria for each article using the PRISMA checklist. The methodological quality of narrative and systematic reviews was evaluated with the INSA and AMSTAR checklists, respectively Results: Our study analyzed a total of 23 studies, including 18 narrative reviews and 5 systematic reviews. Radiotherapy with Brachytherapy, Proton Therapy, SRS/SRT with gamma knife and cyber knife, are the most common choices for the treatment of primary ocular melanoma. These techniques allow for excellent lesion spread control, eye, and vision conservation, and improve overall patients' quality of life. Among the narrative reviews, the highest INSA score was 5/7, the lowest 2/7, the mean was 3.83/7 and median was 4/7. Among the systematic reviews, the highest AMSTAR score was 9/12, the lowest 4/12, the mean 5.6/7 and median 4/7 Conclusion: The number of studies available on this topic is scarce. Among those published, the methodological quality is modest, as assessed with the INSA and AMSTAR checklists. As a result, we are not able to determine what the most effective radiotherapy technique is

Proton beam irradiation. An alternative to enucleation for intraocular melanomas.

Proton irradiation was used in the treatment of uveal melanomas in 36 eyes. The average follow-up period was 16 months. One patient developed metastatic disease and died. No eye has been enucleated and tumor regression has been observed in all 22 eyes with a follow-up of more than 12 months. This type of treatment offers definite advantages over previously used methods, can be used for the treatment of relatively large melanomas, and should be considered before enucleation.

[Problems in juvenile xanthogranuloma of the anterior uvea (author's transl)]. / Zum Problem des juvenilen Xanthogranuloms der vorderen Uvea.

With reference to a case of juvenile xanthogranuloma localized in the anterior uvea the authors describe the clinical signs, differential diagnosis, morphology and treatment of this disease. If the juvenile xanthogranuloma is located in the anterior uvea, the eye may be severely affected. Spontaneous hyphema in infants is characteristic. At present radiation is the most successful treatment for preserving the bulbus and visual function. The earlier the disease is discovered the better the chances of successful treatment.

Leukemic iris infiltration.

A 7-year-old boy with acute lymphocytic leukemia developed iris infiltration, blood-streaked hypopyon, and high intraocular pressure. A diagnostic anterior chamber paracentesis was performed, which provided a cytologic diagnosis. The aspirate was studied by both the millipore filter technique with Papanicolaou stain and a dried smear using the Wright's stain. Wright's stain provided more distinct cellular details. Irradiation of the anterior segment resulted in clearing of leukemic iris infiltration, hypopyon, and glaucoma.