Characteristics and Outcomes of 237 Juxtapapillary Choroidal Melanomas Treated with Iodine-125 Plaque Brachytherapy.

Introduction: Juxtapapillary uveal melanomas limit plaque brachytherapy treatment using the standard 2 mm margin and are often excluded from prospective studies thus limiting data on outcomes and complications. We retrospectively evaluated outcomes in this tumor population following primary iodine-125 plaque brachytherapy. Methods: We performed a retrospective review over 30 years of patients treated with iodine-125 plaque brachytherapy for juxtapapillary uveal melanoma at a single center. Results: Patients were white (97%), male (53.2%), 62 years old (median age, median follow-up of 4.1 years), with right eye involvement (54.4%). At 1, 5, and 10 years, local recurrence was observed in 2.2%, 10%, and 24.6%, enucleation in 0.05%, 11.3%, and 22.1%, metastasis in 1.3%, 6.7%, and 14.2%, and mortality in 1.8%, 14.9%, and 32.8%, respectively. Median visual acuity declined from LogMAR 0.1 to 2.0 at last visit. Radiation retinopathy and optic neuropathy were seen in 54.9% and 46%, respectively, of patients by a median of 742 days (2.03 years) and 1,011.5 days (2.77 years). Conclusions: Juxtapapillary melanomas demonstrated higher rates of vision loss and local recurrence following plaque brachytherapy compared with other tumor configurations. Enucleation, distant metastasis, and overall mortality were comparable to those reported for non-juxtapapillary melanomas.