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We read with interest the study by Beykin et al 1 which appears to show a much higher rate of late retinal detachment following brachytherapy for posterior uveal melanoma than was found during a recent review of our own service.
Between 1998 and 2013, 445 eyes with posterior choroidal melanoma were treated with ruthenium-106 plaque brachytherapy in the Scottish Ocular Oncology Service, and only 1 eye (0.22%) developed a retinal detachment. This contrasts with 7 from 473 eyes (1.48%) reported by Beykin et al. Furthermore, our patient developed a superior macula-off rhegmatogenous detachment 2 days after plaque removal, with a break corresponding to the site of plaque attachment. This contrasts with detachments developed at a mean of 50.1 months post brachytherapy in Beykin's series (with the earliest at 3.5 months), all of which were assumed to relate to late exudative detachment, subretinal fibrosis, retinal thinning and atrophic holes. It is interesting that we did not encounter any ‘degenerative’ detachments of this nature, with our own seemingly similar case mix, management and follow-up.
Beykin et al do not report their rates of vitrectomy for indications other than retinal detachment, but in keeping with other published series, vitreous haemorrhage was the most common indication for vitrectomy following plaque brachytherapy in our patients (7 eyes (1.57%)).2 ,3 One patient developed vitreous haemorrhage 5 weeks after removal of plaque, the remainder much later (mean 5.4 years (range 1.4–8.8 years)) and attributed to tumour necrosis or proliferative radiation retinopathy. During the same study period we also treated 43 cases of posterior uveal melanoma by local resection combined with ruthenium plaque, and 227 with proton beam therapy. Of those with resections, 7 required vitrectomy (4 (9.3%) for retinal detachment, 3 (7.0%) for non-clearing vitreal haemorrhage); 2 eyes (0.9%) developed a retinal detachment following proton beam therapy.
Contributors SNC: data collection and analysis, drafting of manuscript. HBS: data analysis, drafting and final approval of manuscript. EGK: critical review and final approval of manuscript.
Competing interests None.
Ethics approval Anonymous data were obtained from the mandatory oncology database maintained by the Scottish Ocular Oncology Service.
Provenance and peer review Not commissioned; internally peer reviewed.
Data sharing statement Mandatory dataset available for inspection.