[MOL] Melanoma info. [01218] Medicine On Line


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[MOL] Melanoma info.



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Title: Visual Acuity Outcomes Vary after Plaque Radiotherapy for Uveal Melanoma
URL: http://archopht.ama-assn.org/issues/v118n9/abs/ecs90228.html
09/21/2000 03:25:32 PM
By Elda Hauschildt


Patient age, general health and initial visual acuity are among various factors that affect ultimate visual outcome after plaque radiotherapy for uveal melanoma.

Tumor location and size, sub-retinal fluid, radioactive isotope and final tumor control are other factors, Philadelphia researchers report.

"Visual acuity is most effectively preserved in eyes with small tumors outside a radius of five millimetres from the optic disc and foveola," they note.

Investigators studied 1,300 consecutive patients with uveal melanoma and initial visual acuity of 20/100 or better. All of the participants were treated with plaque radiotherapy between July 1976 and June 1992.

Investigators used two end points to evaluate post-treatment visual acuity -- final visual acuity level and loss of visual acuity. Visual acuity was considered good if it ranged from 20/20 to 20/100, and poor for 20/200 to no light perception.

Minimal loss of visual acuity was defined as less than five lines Snellen visual acuity or as moderate when it was equal to or more than five lines.

Results indicate that 1,106 of the participants had visual acuity of 20/100 or better when they began treatment. Of the total, 34 percent had poor visual acuity at five years post-treatment. At 10 years post-treatment, 68 percent had poor visual acuity.

Nine clinical factors were found to best predict poor visual-acuity results. These included increasing tumor thickness, proximity to foveola of less than 5 mm, notched plaque shape, tumor recurrence, age of 60 years or older, sub-retinal fluid, cobalt isotope, anterior tumor margin posterior to equator and worse initial visual acuity.

Moderate loss of visual acuity was found in 33 percent at five-year follow-up and in 69 percent at 10-year follow-up.

Eight factors were related to moderate loss. These were increasing tumor thickness, worse initial visual acuity, notched plaque shape, tumor recurrence, proximity to foveola of less than 5 mm, age 60 years or older, sub-retinal fluid and diabetes mellitus or hypertension.



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