Tumour-lysis-related elevation of intraocular pressure following high-dose rate brachytherapy for choroidal melanoma

Abstract

Purpose. To describe the clinical course and management of acute tumour lysis-related intraocular pressure (IOP) elevation, which is a rare late complication of brachytherapy for choroidal melanoma. Methods. Seven patients out of 36 treated with Iodine-125 brachytherapy were identified who had in common: an uneventful latent period with continuing tumour regression, ended by a sudden massive release of pigmented debris in association with elevated IOP without iris neovascularization. Medications that reduce aqueous production (timolol, dorzolamide, betaxolol, and acetozolamide) were used in combinations to lower IOP. Results. Tumour lysis developed after a mean period of 17.4 months. IOPs ranged between 28 and 35 mmHg, which normalized in a mean period of 10.7 months under topical medications. The seven patients were inadvertently prescribed apical dose rates ranging between 118.3 to 289.16 cGy/h that were significantly higher than the rest of the group (P=0.000). This complication did not develop in patients whose apical dose rates did not exceed 109 cGy/h. Conclusions. Acute tumour lysis associated with an elevated IOP after brachytherapy appears to be related to large tumour size and high dose rates. IOP can be lowered by topical medications but visual prognosis is poor. There is no evidence of any effect on overall prognosis of tumour lysis, elevation of IOP, or its treatment. © 2004 Nature Publishing Group All rights reserved.