Abstract

DO.08.03

Treatment of the exsudative retinal detachment after Brachytherapy of uveal melanomas with Triamcinolone acetonide

Theodora Gkika, Bernhard Jurklies, Christine Jurklies, Michael Freistühler, Harun Akgül, Norbert  Bornfeld
Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen

Objective
The irradiation of uveal melanoma often results in a pronounced increase of the exudative retinal detachment. Purpose of this study is to show the effect intravitreal or sub-Tenon injected triamcinolone acetonide crystal-suspension  (off-label-use) on this type of exudative retinal detachment.
Methods
30 Patients were treated with triamcinolone acetonide. The medication was in 17 eyes intravitreal and in 13 eyes sub-Tenon applied. Triamcinolone acetonide was in 20 patients during plaque removal and in 10 patients after at least 1 month after plaque removal. In 24 cases there was only 1 injection necessary and 6 patients were treated aditionally with a second injection. The mean follow-up time was 10,5 months.
Results
23 (76,7%) of the patients showed a complete resorption of the exudative retinal detachment. These patients were divided into 3 groups. The patients in group A (n=17) were treated with only 1 injection during plaque removal. In group B (n=4) the medication was injected at least 1 month after plaque removal and in group C (n=2) there were 2 injections necessary. The exudative retinal detachment was completelly resorbed after 4,4 months in group A, after 9,5 months in group B and after 24 months after plaque removal in 1 patient of group C. A comparison of the effect of intravitreal against sub-Tenon injections in group A showed that the time of the resorption of the exudative retinal detachment after intravitreal injection was 4,5 months and after sub-Tenon application 4,2 months. In spite of the treatment with triamcinolone acetonide, 7 patients (23,3%) showed a persistent exudative retinal detachment. Because of this pronounced complication after irradiation, 2 patients underwent enucleation and 1 patient pars plana vitrectomy with silicon oil tamponade.
Conclusions
In order to achieve an optimal treatment of this acute irradiation-induced complication, a triamcinolone acetonide injection is recomended intraoperatively during plaque removal. An injection applied later on has a geringer effect and can lead to a compromising clinical outcome, which may necessitate a pars plana vitrectomy or even an enucleation of the eye.

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