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Long‐term visual acuity preservation after proton therapy for peri‐ and parapapillary melanoma patients treated at the Paul Scherrer Institute
Author(s) -
Pica A.,
Hrbacek J.,
Zografos L.,
Schalenbourg A.,
Wagner H.,
Vallat L.,
Walser M.,
Schneider R.,
Weber D.C.
Publication year - 2016
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2016.0342
Subject(s) - medicine , visual acuity , ophthalmology , optic nerve , surgery , nuclear medicine
Purpose To assess long‐term visual acuity (VA) preservation in patients with peri‐ and parapillary melanoma after proton therapy (PT). Methods We evaluated 24 high‐risk for visual impairment patients with yet preserved long‐term VA treated from March 1987 through December 2004 at the Paul Scherrer Institute. Results Median follow‐up was 11 years (range: 5.2–22.3). Mean patient's age was 51.3 years. Median tumor height was 2.8 mm (range: 1.8–5.2) and largest basal diameter, 11.4 mm (range: 6–17.9). In 9 patients (37.5%) the tumors abutted the optic disk, while 15 patients (62.5%) presented with tumors at a median distance of 1 mm (range: 0.1–2.4) and 2 mm (range: 0.1–5.7) from the optic disk and macula, respectively. Median baseline VA was 1.0 (range: 0.4–1.5). Between the second and eight year after PT, slight variations of median VA were observed, which however remained stable at 0.9 (range: 0.5–1.25). Thereafter, VA decreased under 0.6 in 7 (29%) patients. Seven patients (29%) developed papillopathy (median at 3 years after PT), with one of them losing useful VA (0.01), 22 years following PT. Macular area receiving ≥ 30 CGE was an unfavorable prognostic factor for preserving long‐term useful VA. Conclusions Preservation of visual function in some of these cases could be consequential to reduced radiation exposure to the macula and optic nerve behind the disk. We speculate on a possible role of the posterior ciliary artery (PCA) and their capillary anastomoses, protecting the papillo‐macular area from ischemia.