Periocular triamcinolone for prevention of macular edema after iodine 125 plaque radiotherapy of uveal melanoma.

OBJECTIVE: To investigate the potential benefit of periocular depot triamcinolone in the prevention of macular edema after iodine 125 plaque radiotherapy for uveal melanoma. METHODS: This comparative, nonrandomized, interventional study included 87 patients with uveal melanoma who underwent plaque radiotherapy. The triamcinolone group included 55 consecutive patients who were treated with 40 mg of periocular triamcinolone at the time of plaque application and 4 months and 8 months later. The comparison group comprised 32 consecutive patients treated with plaque radiotherapy without triamcinolone. Patients were evaluated at 4 months, 8 months, 12 months, 18 months, and 24 months after plaque application with clinical examination, fundus photography, and optical coherence tomography (OCT). The associations of clinical variables with the development of OCT-evident macular edema (the main outcome measure) were investigated using Cox proportional hazards analysis. RESULTS: By multivariate analysis, eyes treated with periocular triamcinolone had a significant reduction in the risk of radiation-induced macular edema (P = 0.002; hazard estimate = 0.49; 95% confidence interval, 0.17- 0.80). Adverse effects associated with periocular triamcinolone treatment included elevation of intraocular pressure (7% of cases) and blepharoptosis (5% of cases). CONCLUSIONS: Periocular triamcinolone treatment significantly lowered the risk of macular edema after plaque radiotherapy for uveal melanoma in this series but did not significantly alter the rate of vision loss at 24 months of follow-up.

Duke Scholars

Author Miguel Angel Materin Ophthalmology, Vitreoretinal Diseases & Surgery