There is controversy surrounding whether to perform intraocular surgery in eyes with uveal melanoma because of concerns about orbital dissemination and fear of a possible increase in the metastatic risk.
The results of a recent study should put those fears to rest in that the chief finding was that vitrectomy performed at the time of brachytherapy does not increase patients’ metastatic prognosis.
Tara McCannel, MD, PhD, and colleagues have identified a number of benefits associated with the use of silicone oil. In previous studies, they established that silicone oil of 1,000 cSt can attenuate radiation during brachytherapy by from 50% to 60%, reduce radiation retinopathy by 2 years, delay the severity of progression of angiographic radiation retinopathy, and significantly improve vision in patients with a large choroidal melanoma compared to plaque therapy alone at 2 years.
Dr. McCannel, director of the Ophthalmic Oncology Center, Jules Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles (UCLA), explained how silicone oil works in preventing radiation retinopathy.
“When treating melanoma, we place a plaque on the sclera,” Dr. McCannel explained. “To actively treat the lesion, some of the radiation affects the other healthy tissues in the eye. If we can replace the vitreous with a substitute that contains the iodine-125 radiation, such as silicone oil, then the radiation effect on the healthy tissues can be minimized.”