Abstract:
Importance:Early detection of choroidal melanoma at a small tumor size is emphasized in the literature. However, there is little published information on the specific risks of plaque-irradiated small choroidal melanoma on visual acuity and metastasis. Objective:To analyze outcomes of plaque radiotherapy for small choroidal melanoma 3 mm in thickness or less. Design, Setting, and Participants:This retrospective noncomparative series at a tertiary referral center included 1780 consecutive patients who had received plaque radiotherapy treatment for small choroidal melanoma. Main Outcomes and Measures:Visual acuity outcomes and melanoma-associated metastasis, assessed by Kaplan-Meier analyses. Results:The mean (SD) patient age at melanoma diagnosis was 58 (14) years. Of 1780 patients, 908 were female (51.0%), and 1752 were white (98.4%). Visual acuity was 20/40 OU or better in 1276 of the patients (71.7%), and the mean (SD) visual acuity was 20/40 (20/50) OU (median, 20/30; range, 20/20 to counting fingers). The mean (SD) tumor basal dimension was 8.8 (2.9) mm (median, 8.0 mm; range, 2.0-20.0 mm) and mean (SD) tumor thickness was 2.6 (0.5) mm (median, 2.7; range, 0.2-3.4 mm). Mean (SD) distance to the foveola was 3.4 (3.9) mm and to the optic disc was 3.7 (3.7) mm. The Kaplan-Meier rate of visual acuity loss (≥3 Snellen lines) was 9.5% (95% CI, 8.2%-11.0%) at 1 year, 39.2% (95% CI, 36.5%-42.0%) at 5 years, and 48.9% (95% CI, 45.6%-52.3%) at 10 years, whereas poor visual acuity (≤20/200) was 7.1% (95% CI, 5.9%-8.4%) at 1 year, 38.2% (95% CI, 35.5%-41.1%) at 5 years, and 53.5% (95% CI, 50.1%-57.1%) at 10 years. Regarding melanoma-associated metastasis, the rate was 0.2% (95% CI, 0.09%-0.6%) at 1 year, 4.5% (95% CI, 3.4%-5.9%) at 5 years, and 8.8% (95% CI, 6.9%-11.1%) at 10 years. Using 1.0-mm thickness increments, the 10-year risk for metastasis was 25.0% (95% CI, 3.9%-87.2%) at 0-mm to 1.0-mm thickness, 5.9% (95% CI, 2.5%-13.5%) at 1.1-mm to 2.0-mm thickness, 8.1% (95% CI, 5.9%-11.0%) at 2.1-mm to 3.0-mm thickness, and 13.4% (95% CI, 8.7%-20.4%) at thicknesses greater than 3.0 mm. The greater relative risk (RR) for metastasis in thinnest tumors was 1.83 (95% CI, 1.09-3.07), which likely represented more aggressive diffuse (flat) melanoma. By multivariable analysis, clinical features predictive of melanoma-associated metastasis included increasing patient age (RR, 1.32 [95% CI, 1.07-1.63] per decade; P = .01), tumor diameter (RR, 1.15 [95% CI, 1.06-1.24] per mm; P < .001), tumor thickness (RR, 2.22 [95% CI, 1.22-4.05] per mm; P = .01), photopsia symptoms (RR, 2.45 [95% CI, 1.35-4.43]; P = .003), and prior treatment before plaque radiotherapy (RR, 3.31 [95% CI, 1.31-8.33]; P = .01). Conclusions and Relevance:This retrospective study suggests that small choroidal melanoma treated with plaque radiotherapy has a 10-year risk for visual acuity loss of 48.9% (95% CI, 45.6%-52.3%) and a 10-risk of systemic metastasis of 8.8% (95% CI, 6.9%-11.1%). In this analysis, each millimeter of increasing thickness and diameter contributed risk for metastatic disease.
journal_name
JAMA Ophthalmoljournal_title
JAMA ophthalmologyauthors
Shields CL,Sioufi K,Srinivasan A,Di Nicola M,Masoomian B,Barna LE,Bekerman VP,Say EAT,Mashayekhi A,Emrich J,Komarnicky L,Shields JAdoi
10.1001/jamaophthalmol.2018.3881subject
Has Abstractpub_date
2018-12-01 00:00:00pages
1325-1333issue
12eissn
2168-6165issn
2168-6173pii
2704059journal_volume
136pub_type
杂志文章abstract:IMPORTANCE:The potential effect of treatments for diabetic macular edema (DME) on driving should be of value to patients and clinicians, such as ophthalmologists and other physicians, who treat patients with diabetes mellitus. OBJECTIVE:To determine the effect of ranibizumab on driving and patient-reported vision func...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2015-09-01 00:00:00
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journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
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abstract:Importance:Despite the existing country-specific strategies tackling social inequalities in visual health in adults, little is known about trends in visual function in childhood and its association with social position. Objective:To investigate the distribution of childhood visual function in the United Kingdom and as...
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pub_type: 杂志文章
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abstract:IMPORTANCE:This study confirmed the long-term outcomes of the ZB5M phakic intraocular lens (PIOL). OBJECTIVE:To evaluate the potential long-term risk associated with ZB5M PIOL implantation. DESIGN, SETTING, AND PARTICIPANTS:A retrospective, nonrandomized, consecutive cohort study of a total of 208 eyes implanted with...
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2013-02-01 00:00:00
abstract:Importance:The comparative clinical effectiveness of ranibizumab, aflibercept, and bevacizumab for the management of macular edema due to central retinal vein occlusion (CRVO) is unclear. Objective:To determine whether intravitreal aflibercept or bevacizumab compared with ranibizumab results in a noninferior mean chan...
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abstract:Importance:Some eyes with neovascular age-related macular degeneration (AMD) have persistent exudation despite frequent intravitreal anti-vascular endothelial growth factor (VEGF) injections. Adjuvant therapies that further reduce edema may improve vision outcomes. Objective:To compare the short-term effect of topical...
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pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2020-05-01 00:00:00
abstract:IMPORTANCE:Acanthamoeba keratitis is a debilitating eye disease that requires effective topical drug therapy. Currently, there is no standard in vitro test to evaluate anti-Acanthamoeba drugs. OBJECTIVE:To develop a practical in vitro complete-kill assay to assess anti-Acanthamoeba drugs. DESIGN AND SETTING:Isolates ...
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pub_type: 杂志文章
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更新日期:2013-11-01 00:00:00
abstract:OBJECTIVE:To determine whether treatment of choroidal melanoma influences survival by correlating age at death, cause of death, age at treatment, and survival predictors. DESIGN, SETTING, AND PARTICIPANTS:Prospective cohort study performed at the Liverpool Ocular Oncology Centre, a supraregional, tertiary referral ser...
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更新日期:2020-08-01 00:00:00
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更新日期:2014-06-01 00:00:00
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更新日期:2013-12-01 00:00:00
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