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Dry eye syndrome following proton therapy of ocular melanomas
Author(s) -
Maschi C.,
Sara L.,
Peyrichon M.L.,
Baillif S.,
Herault J.,
Thariat J.,
Caujolle J.P.
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.1755-3768.2016.0694
Subject(s) - medicine , enucleation , lacrimal gland , melanoma , choroid , ophthalmology , cornea , eyelid , ciliary body , surgery , pathology , retina , physics , cancer research , optics
Purpose Some institutions contra‐indicate proton therapy (PT) for ocular melanomas of temporal superior location (TS) owing to lacrimal gland irradiation and the risk of dry eye syndrome (DES) and advocate brachytherapy. We investigated whether PT can be safely performed in TS melanomas. Methods Location, DES grade and dose to the lacrimal gland estimated from Eyeplan blindly by two operators were correlated in consecutive patients treated from 1999 to 2014 with 52 Gy Results Of 1473 patients, 13.6% had DES, including 5.4% with severe DES (sDES). Temporal superior and temporal melanoma patients had a higher risk of DES than patients with melanomas in other quadrants (p < 0.001). Severe DES was noted in 18.6% of TS melanoma patients (versus 5.4% in patients with melanomas in all other quadrants) and 12.3% of temporal melanoma patients (versus 3.0%) (p < 0.001). sDES was more frequent in ciliary versus choroid melanomas, advanced versus early stage (p < 0.001), and higher percentages of eye surface, lens periphery or ciliary body (p < 0.001), cornea irradiated at any dose level (p = 0.002). sDES was associated with more eyelid dermatitis or alopecia (p < 0.001), and glaucoma/rubeosis (p = 0.002). Vision changes were similar in patients with TS melanoma or other locations, including for patients experiencing severe DES (+1.15 vs. +1.14 logMAR). No patient underwent enucleation for complications of DES. Conclusions DES and sDES were more frequent in TS melanomas incriminating the lacrimal gland but temporal melanomas experienced more DES. In addition to correlation sDES and lens, cornea and lid irradiation, this suggests involvement of such structures as the limbus cells, conjunctival glands and long ciliary nerves. Rates of sDES compared favorably with the literature and DES was manageable. Tumor location should not contraindicate PT.