Management of radiation-induced severe anophthalmic socket contracture in patients with uveal melanoma

Qasiem J. Nasser, Dan S. Gombos, Michelle D. Williams, B. Ashleigh Guadagnolo, William H. Morrison, Adam S. Garden, Beth M. Beadle, Elvia Canseco, Bita Esmaeli

Research output: Contribution to journalReview article

10 Scopus citations

Abstract

PURPOSE: High-dose radiotherapy can cause contracture of the anophthalmic socket, but the incidence of this complication in patients with enucleation for uveal melanoma has not been reported previously. The authors reviewed the surgical management and outcomes in terms of successful prosthesis wear in patients with severe contracture of the anophthalmic socket treated with high-dose radiotherapy for high-risk uveal melanoma, and they estimated the relative risk of this complication. METHODS: The medical records of all consecutive patients enrolled in a prospective uveal-melanoma tissue-banking protocol at the authors' institution who underwent enucleation between January 2003 and December 2010 were reviewed. Patients who underwent adjuvant radiotherapy of the enucleated socket were further studied. RESULTS: Of the 68 patients enrolled in the prospective tissue-banking protocol, 12 had high-risk histologic features (e.g., extrascleral spread or vortex vein invasion) and were treated with 60 Gy of external beam radiotherapy after enucleation. Five of these patients (41.7%) experienced severe socket contracture precluding prosthesis wear. The median time to onset of contracture following completion of radiotherapy was 20 months. Three patients underwent surgery, which entailed scar tissue release, oral mucous membrane grafting, and socket reconstruction; 2 patients declined surgery. All 3 patients who had surgery experienced significant improvement of socket contracture that enabled patients to wear a prosthesis again. CONCLUSION: High-dose radiotherapy after enucleation in patients with uveal melanoma caused severe socket contracture and inability to wear a prosthesis in approximately 40% of patients. Surgical repair of the contracted socket using oral mucous membrane grafting can allow resumption of prosthesis wear.

Original languageEnglish (US)
Pages (from-to)208-212
Number of pages5
JournalOphthalmic Plastic and Reconstructive Surgery
Volume28
Issue number3
DOIs
StatePublished - May 2012

ASJC Scopus subject areas

  • Surgery
  • Ophthalmology

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