Outcome of Secondary Glaucoma in Eyes With Uveal Melanoma A Population-Based Analysis.

PRCIS: Over 50% of eyes with uveal melanoma and secondary glaucoma with ≥20/400 vision retain that level through 5 years, and over 90% with <20/400 vision are pain-free. Over 90% avoid secondary enucleation for intractable glaucoma.

PURPOSE: To report outcome of secondary glaucoma in uveal melanoma eyes mainly treated with brachytherapy.

PATIENTS AND

METHODS

Of 186 consecutive patients with uveal melanoma and secondary glaucoma, 49 (26%) with ≥20/400 vision were assigned to therapeutic and 137 (74%) with <20/400 vision to palliative group. Glaucoma-related medications and procedures were recorded. Main outcome measures were best corrected visual acuity, pain, and enucleation.

RESULTS

The therapeutic group had thinner (median, 7.5 vs. 9.1 mm), more anterior tumors (median distance to disc and foveola, 10 vs. 3.5 mm and 12 vs. 3.6 mm, respectively; 29% vs. 11% iris melanomas) than the palliative group. The main mechanism of secondary glaucoma was angle invasion (45%) and neovascularization (71%), respectively. In the therapeutic group, 96% and 47% of eyes were managed with medication and cyclophotocoagulation, respectively, compared to 77% and 20% in the palliative one. At 1, 3, and 5 years, 60%, 69%, and 67% in the therapeutic group were normotensive (4-21 mmHg), 63%, 55%, and 58% preserved ≥20/400 vision, and 28%, 36%, and 46% also retained ≥20/60 vision, respectively. Low vision at patient level (3%, 4%, and 5%, respectively) was exceptional. In the palliative group, 84%, 92%, and 96% were free of pain, respectively, and cumulative incidence of enucleation for secondary glaucoma was 9% by 5 years.

CONCLUSIONS

Most uveal melanoma eyes with secondary glaucoma and useful vision potential become normotensive with medication and cyclophotocoagulation and retain ≥20/400 vision. Most with less visual potential become pain-free without intensive medication and avoid enucleation.