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Extraocular muscle repositioning and diplopia: associated with ophthalmic plaque radiation therapy for choroidal melanoma.

Abstract：

OBJECTIVE:To evaluate extraocular muscle surgery associated with plaque brachytherapy for choroidal melanoma. DESIGN:Single-center retrospective cohort study. PARTICIPANTS:Three hundred twenty-nine eyes of 329 consecutive patients with clinically diagnosed choroidal melanoma. INTERVENTION:Palladium 103 plaque brachytherapy with or without extraocular muscle surgery. MAIN OUTCOME MEASURES:Type of muscle surgery required for each tumor location, timing, incidence, and duration of diplopia, as well as treatment. RESULTS:Two hundred fifty-four patients (n = 254/329; 77.2%) required muscle surgery. One hundred seven patients (n = 107/329; 32.5%) required surgery on 2 or more muscles. Of 373 muscles repositioned, the lateral rectus muscle (n = 115/373; 30.8%) and inferior oblique muscle (n = 70/373; 18.7%) were the most common, correlating to intraocular tumor location (P<0.001). Only 6 tumors (n = 6/61; 9.5%) originating from the iris and ciliary body required muscle surgery for plaque placement. Of the 312 patients with a preoperative visual acuity better than 20/400, diplopia was reported at the first postoperative visit by 41 patients (n = 41/312; 13.1%), 2 of whom had not undergone muscle surgery. Diplopia resolved spontaneously within 1 month in 18 patients (n = 18/41; 43.9%), between 1 and 6 months in 12 patients (n = 12/41; 29.3%), and at more than 6 months in 5 patients (n = 5/41; 12.2%). Among the 312 patients, persistent diplopia occurred in 6 patients (1.9%), including 1 who had not undergone muscle surgery. Treatment was declined in 1 patient, 3 patients (n = 3/41; 7.3%) were treated with prisms, and 2 patients (n = 2/41; 4.9%) required surgery. CONCLUSIONS:Extraocular muscle surgery frequently is required for plaque brachytherapy. Although transient diplopia occurred in 11.2% of patients, persistent diplopia occurred in only 1.9% of patients and was treatable.

journal_name

Ophthalmology

journal_title

Ophthalmology

authors

Nagendran ST,Finger PT,Campolattaro BN

doi

10.1016/j.ophtha.2014.05.037

subject

Has Abstract

pub_date

2014-11-01 00:00:00

pages

2268-74

issue

eissn

0161-6420

issn

1549-4713

pii

S0161-6420(14)00510-7

journal_volume

121

pub_type

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Extraocular muscle repositioning and diplopia: associated with ophthalmic plaque radiation therapy for choroidal melanoma.