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Original Investigation
December 12, 2019

Visual Outcome at 4 Years Following Plaque Radiotherapy and Prophylactic Intravitreal Bevacizumab (Every 4 Months for 2 Years) for Uveal Melanoma: Comparison With Nonrandomized Historical Control Individuals

Author Affiliations
  • 1Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
  • 2Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
  • 3Chulabhorn Hospital, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
JAMA Ophthalmol. 2020;138(2):136-146. doi:10.1001/jamaophthalmol.2019.5132
Key Points

Question  Is prophylactic intravitreal bevacizumab associated with improvement in visual acuity in eyes with plaque-irradiated uveal melanoma?

Findings  In a cohort study of 1131 eyes with plaque-irradiated uveal melanoma treated with intravitreal bevacizumab at 4-month intervals for 2 years, visual outcome was better at 1, 2, 3, and 4 years, with 4-year median visual acuity of 20/70 compared with counting fingers in a nonrandomized, control (nonbevacizumab) group.

Meaning  These findings suggest prophylactic intravitreal bevacizumab may be associated with improved visual outcome up to 4 years for patients with irradiated uveal melanoma.

Abstract

Importance  Radiation retinopathy following plaque radiotherapy for uveal melanoma can lead to vision loss that might be avoided with prophylactic anti–vascular endothelial growth factor treatment.

Objective  To determine visual outcome following prophylactic intravitreal bevacizumab in patients with plaque-irradiated uveal melanoma.

Design, Setting, and Participants  Retrospective, nonrandomized, interventional cohort study at Wills Eye Hospital, Philadelphia, Pennsylvania. Prophylactic bevacizumab was administered between 2008 and 2018 to 1131 eyes with irradiated uveal melanoma (bevacizumab group) and compared with 117 eyes with irradiated uveal melanoma between 2007 and 2009 (no bevacizumab [historical control] group).

Interventions  Prophylactic intravitreal bevacizumab was provided at the time of plaque removal as well as 6 subsequent injections at 4-month intervals over 2 years.

Main Outcomes and Measures  Visual acuity.

Results  The median patient age was 61 years, 1195 of 1248 patients were white (96%), and 632 of 1248 were women (51%). The median tumor thickness was 4.0 mm, and median distance to foveola was 3.0 mm. A difference was not identified (bevacizumab vs control group) in demographic features, clinical features, or radiation parameters. The mean follow-up was 40 months vs 56 months (mean difference, −18; 95% CI, −24 to −13; P < .001). By survival analysis, the bevacizumab group demonstrated less optical coherence tomography evidence of cystoid macular edema at 24 months (28% vs 37%; hazard ratio [HR], 1.5; 95% CI, 1.1-2.2; P = .02) and 36 months (44% vs 54%; HR, 1.5; 95% CI, 1.1-2.1; P = .01), less clinical evidence of radiation maculopathy at 24 months (27% vs 36%; HR, 1.5; 95% CI, 1.0-2.2; P = .03), 36 months (44% vs 55%; HR, 1.50; 95% CI, 1.1-2.0; P = .01), and 48 months (61% vs 66%; HR, 1.4; 95% CI, 1.0-1.9; P = .03), and less clinical evidence of radiation papillopathy at 18 months (6% vs 12%; HR, 2.0; 95% CI, 1.1-3.9; P = .04). Nonparametric analysis documented better visual acuity outcomes in the bevacizumab group at all points, including 12 months (median logMAR visual acuity [Snellen equivalent]: 0.30 [20/40] vs 0.48 [20/60]; mean difference, −0.28; 95% CI, −0.48 to −0.07; P = .02), 24 months (0.40 [20/50] vs 0.70 [20/100]; mean difference, −0.52; 95% CI, −0.75 to −0.29; P < .001), 36 months (0.48 [20/60] vs 1.00 [20/200]; mean difference, −0.49; 95% CI, −0.76 to −0.21; P = .003), and 48 months (0.54 [20/70] vs 2.00 [counting fingers]; mean difference, −0.71; 95% CI, −1.03 to −0.38; P < .001).

Conclusions and Relevance  These findings from a retrospective cohort of plaque radiotherapy and prophylactic intravitreal bevacizumab in patients with uveal melanoma suggest better visual outcomes when compared with nonrandomized historical control individuals through 4 years.

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