gms | German Medical Science

Purpose: An acute complication occuring after brachytherapy is the so called “toxic tumor syndrome”. Large uveal melanomas disintergrade often very quickly during and directly after irradiation. This is often leading to an intraocular inflammatory reaction, uveal detachment, and an increasing exudative retinal detachment. The effect of intravitreal injection or injection applied to the sub-Tenon space was compared to the results after pars plana Vitrectomy with silicon oil tamponade.

Methods: A total of 60 patients was treated with triamcinolone injections. In 29 patients the medication was applied in the vitreous cavity and in 31 patients in the sub-Tenon space. In 50 cases the injection was given within a month after brachytherapy and in 10 eyes later on. 20 eyes with a persistent retinal detachment underwent a pars plana Vitrectomy 6,6 months after plaque removal.

Results: 49 patients treated with triamcinolone, presented a complete resorption of the exudative retinal detachment. These patients were divided in 3 groups. In group A (n=38) only 1 injection was applied within a month after brachytherapy. In group B (n=5) the medication was applied after at least one month after brachytherapy and in group C (n=6) there were 2 injections necessary. In group A the exudative retinal detachment resorbed within 4,15 months, in group B after 13,2 months and in group C within 5,95 months after brachytherapy. The resorption of the exudative retinal detachment occured after a mean of 4,1 months after intravitreal application of the medication and after 4,2 months after the injection in the sub-Tenon space. From the 20 patients in the vitrectomy group, 6 patients underwent removal of the silicon oil combined with phacoemulsification and IOL-implantation, 2 eyes underwent 2 more additional vitrectomies due to a recurrent retinal detachment. Primary and final visual acuity were comparable in both groups (triamcinolone vs vitrectomy). No tumor recurrence was noticed.

Conclusions: For an optimal treatment of the exudative retinal detachment, an injection of triamcinolone is recommended in combination with the plaque removal. A pars plana Vitrectomy is an invasive treatment modality with a higher complications rate compared to an intravitreal injection. In cases of persistent retinal detachment or retinal detachment with rhegmatogenous components a pars plana Vitrectomy is the treatment of choice.