February 03, 2020
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Iodine-125 brachytherapy treatment poses glaucoma risk

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Patients treated with iodine-125 brachytherapy for uveal melanoma could have a substantial risk for developing open-angle or neovascular glaucoma.

Of 374 eyes treated with iodine-125 brachytherapy, 31 were later diagnosed with secondary open-angle glaucoma, while 25 were diagnosed with neovascular glaucoma in a retrospective case series.

The study included a single surgeon’s patients who underwent primary iodine-125 brachytherapy between Jan. 1, 2004, and June 30, 2014. Those who had a preexisting glaucoma diagnosis were excluded from review. The median follow-up period was 2.14 years.

Eyes that developed secondary open-angle glaucoma had a peak IOP of 33.1 ± 6.8 mm Hg. Thirty received medical therapy, while one required a glaucoma drainage device. Eyes that developed neovascular glaucoma had a mean maximum IOP of 41.5 mm Hg. In 21 eyes, medical therapy was performed, while the other four required a glaucoma drainage device.

The study also recorded additional risk factors.

“The risks of secondary open-angle glaucoma correlated significantly with increased age, greater baseline IOP, larger melanoma size, melanoma involving the ciliary body and in cases where vitrectomy with silicone oil placement was performed for radiation attenuation,” the study authors wrote.

Neovascular glaucoma development was associated with a higher grade of radiation retinopathy severity.

The authors said that the risk for glaucoma development is substantial and that close monitoring should be conducted for any patient receiving iodine-125 brachytherapy.

“The importance of monitoring for secondary open-angle glaucoma and neovascular glaucoma in patients treated with iodine-125 brachytherapy for uveal melanoma must be emphasized so that appropriate treatment may be delivered in a timely fashion to maximize the visual outcome of patients,” they wrote. “Unlike many other complications of radiation therapy, glaucoma is a treatable disease where vision loss may be prevented with prompt therapy.” – by Rebecca L. Forand

 

Disclosures: The authors report no relevant financial disclosures.