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Central subfield thickness predicts visual acuity outcomes in plaque-irradiated eyes with choroidal melanoma

  • Oncology
  • Published:
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Abstract

Objective

To determine the association between pre-operative central subfield thickness (CST) and post-radiotherapy visual acuity (VA), cystoid macular edema (CME), and intravitreal anti-vascular endothelial growth factor (VEGF) requirement.

Design

Single-center retrospective study.

Participants

Patients with plaque-irradiated extramacular choroidal melanoma treated between 11/11/2011 and 4/30/2021. Pre-operative CST difference between the affected and unaffected eye was used. Kaplan-Meier analysis and hazard ratios were calculated.

Results

Of 85 patients, pre-operative CST was greater in the melanoma-affected eye (vs. fellow eye) by mean of 20.4 μm (median 14.0, range − 60.0–182.0). Greater CST at presentation (vs. fellow eye) was associated with larger tumor diameter (p = 0.02), greater tumor thickness (p < 0.001), and more frequent tumor-related Bruch’s membrane rupture (p = 0.006). On univariate analysis of outcome data, greater CST at presentation (vs. fellow eye) was associated with higher 5-year risk (1.09 [1.02–1.17], p = 0.02) of VA 20/200 or worse and increased (1.10 [1.01–1.20], p = 0.03) likelihood for anti-VEGF injections after plaque irradiation. There was no significant association with CME. The association between CST and VA outcome remained significant on multivariate analysis accounting for impact of tumor thickness and radiation dose to optic disc, while tumor distance to fovea was the only significant factor on multivariate analysis for anti-VEGF injections.

Conclusion

Greater CST at presentation (vs. fellow eye) was associated with worse VA outcome following plaque radiotherapy for choroidal melanoma. Large-sized tumors may contribute to a higher intraocular VEGF burden, potentially leading to greater preoperative CST, which correlates with poor VA outcome post-plaque radiotherapy.

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Acknowledgements

The authors would like to thank David O. Hodge, M.S. at Mayo Clinic, Rochester, MN, for his statistical guidance.

Funding

This study was funded by the Mayo Clinic Foundation for Medical Research. This publication was made possible through the support of the Leonard and Mary Lou Hoeft Career Development Award Fund in Ophthalmology Research. This publication was supported by Grant Number P30 CA015083 from the National Cancer Institute. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. This publication was also supported by CTSA Grant Number KL2 TR002379 from the National Center for Advancing Translational Science (NCATS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA

    Saumya M. Shah, Timothy W. Olsen & Lauren A. Dalvin

  2. Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA

    Laurel B. Tanke

  3. Department of Radiation Oncology, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA

    Christopher L. Deufel, Ivy A. Petersen & Kimberly S. Corbin

  4. Department of Biomedical Statistics and Informatics, Mayo Clinic Alix School of Medicine, Rochester, MN, 55905, USA

    David O. Hodge

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  1. Saumya M. Shah
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Correspondence to Lauren A. Dalvin.

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Ethics approval

The Mayo Clinic Institutional Review Board deemed this study exempt as a retrospective chart review, and informed consent was obtained from all patients for inclusion in the IRB-approved Prospective Ocular Tumors Study (POTS) database.

Competing interests

The other authors have no relevant financial disclosures. Dr. Olsen is a board member of the American Academy of Ophthalmology, holds an unrelated grant NIH/NEI R41EY028803 Novartis, and holds unrelated patents #08083751, #1986581, #9539082, #10278808.

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Lauren A. Dalvin, M.D. has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Shah, S.M., Tanke, L.B., Deufel, C.L. et al. Central subfield thickness predicts visual acuity outcomes in plaque-irradiated eyes with choroidal melanoma. Graefes Arch Clin Exp Ophthalmol 262, 1305–1320 (2024). https://doi.org/10.1007/s00417-023-06313-9

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  • DOI: https://doi.org/10.1007/s00417-023-06313-9

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