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Iris melanoma: factors predictive of post-management secondary glaucoma in 271 cases at a Single Ocular Oncology Centre

Eye volume 37, pages 938–946 (2023)Cite this article

Subjects

Abstract

Background/Aims

To identify factors predictive of post-management secondary glaucoma in eyes with iris melanoma.

Methods

Patients with iris melanoma who were conservatively managed on the Ocular Oncology Service, Wills Eye Hospital from 1970 to 2016 were included. Charts were retrospectively reviewed, and binary logistic regression analysis was performed. Main outcome measures were factors predictive of post-management glaucoma, defined as intraocular pressure (IOP) > 22 mmHg following melanoma treatment.

Results

Of 271 patients with iris melanoma, melanoma-related glaucoma was identified in 40 (15%) at presentation and post-management glaucoma developed in 75 (28%) at a mean of 103.7 months (range:1.0-120.0). Comparison (post-management glaucoma vs. no glaucoma) revealed patients with post-management glaucoma presented with worse visual acuity (20/50-20/150) (17% vs. 5%, p = 0.001), increased mean tumour basal diameter (5.1 mm vs. 4.3 mm, p = 0.004), greater melanoma-related increased IOP on presentation (24.1 mmHg vs. 16.2 mmHg, p < 0.001), diffuse tumour shape (9% vs. 4%, p = 0.01), American Joint Committee on Cancer (AJCC) T4 category (7% vs. 2%, p = 0.03), and extraocular tumour extension (7% vs. 2%, p = 0.03). Risk factors for post-management glaucoma identified by multivariate analysis included melanoma-related increased IOP at presentation (OR:1.1, [1.08–1.22] per 1-mmHg increase, p < 0.001), increased mean tumour basal diameter (OR:1.17, [1.02–1.33] per 1-millimetre increments, p = 0.03), advanced AJCC clinical T subcategory (OR:1.23, [1.04–1.46] per 1-subcategory increments, p = 0.02) and plaque radiotherapy treatment (OR:2.32, [1.13–4.75], p = 0.02).

Conclusion

Features of iris melanoma that predicted post-management glaucoma included melanoma-related increased IOP on presentation, advanced AJCC clinical T subcategory, increased mean tumour basal diameter, and plaque radiotherapy treatment.

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Fig. 1: Kaplan-Meier survival analyses of post-management glaucoma development and visual acuity decline in eyes with iris melanoma.

Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Accepted for paper presentation at the Annual Meeting of the American Academy of Ophthalmology from November 13–15, 2020.

Funding

Eye Tumor Research Foundation, Philadelphia, PA (CLS) and the American Glaucoma Society’s Mentoring for the Advancement of Physician Scientists Grant (AGS). The funders had no role in the design and conduct of the study, in the collection, analysis and interpretation of the data, and in the preparation, review or approval of the manuscript. No conflicting relationship exists for any author. Aakriti G. Shukla, M.D. has had full access to all the data in the study and takes responsibility for the integrity of the data.

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Authors and Affiliations

  1. Glaucoma Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 11th Floor, Philadelphia, PA, 19107, USA

    Aakriti Garg Shukla & Jonathan S. Myers

  2. Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA

    Aakriti Garg Shukla, Jonathan S. Myers, Jerry A. Shields & Carol L. Shields

  3. Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA, 19107, USA

    Sarangdev Vaidya, Antonio Yaghy, Maura Di Nicola, Swathi Kaliki, Enzo Fulco, Jerry A. Shields & Carol L. Shields

Authors
  1. Aakriti Garg Shukla
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  7. Jonathan S. Myers
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Contributions

AGS: conceptualization, methodology, writing - original draft, supervision. SV: conceptualization, methodology, formal analysis, visualization, writing -reviewing and editing. AY: conceptualization, methodology, writing-reviewing and editing. MDN: investigation, writing-reviewing and editing. SK: investigation, writing—reviewing and editing. EF: investigation, writing-reviewing and editing. JSM: writing-reviewing and editing. JAS: writing- reviewing and editing, funding acquisition. CLS: conceptualization, methodology, writing-reviewing and editing, funding acquisition, supervision.

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Correspondence to Aakriti Garg Shukla.

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Shukla, A.G., Vaidya, S., Yaghy, A. et al. Iris melanoma: factors predictive of post-management secondary glaucoma in 271 cases at a Single Ocular Oncology Centre. Eye 37, 938–946 (2023). https://doi.org/10.1038/s41433-022-02051-0

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