Scleral thinning after brachytherapy for choroidal melanoma

[alegz]

Good morning --
I underwent brachytherapy a couple of years ago to treat a small choroidal melanoma. The operation was successful and the tumor has been inactive ever since. Recently side effects have started to show in routine checks, like the appearance of cataracts in the area of the lens directly in front of the tumor (which was very fortunately peripheral).

My question concerns scleral thinning. I have not seen posts on the topic, so discussing this may be also helpful to others. I had not noticed the thinning before very recently but it looks now quite dramatic in the area of the plaque: internal pressure of the eye is making the thinner zone of the sclera to bulge, on top of showing the darker color of the choroid below. In my case it is the result of the radiation, since from what I understand it can also happen as a result of the surgery (if they have to temporarily cut the eye muscles to sew the plaque.) My doctor says that it is now just a matter of monitoring the development of the bulge in question, to see whether at some point a graft may be needed to reinforce the sclera before perforation can occur.

I have tried to read a little bit of the literature on side-effects of radiation therapy in cases of uveal melanomas, to see if there was information on likely progression of the thinning. It seems from my layman's reading that scleral thinning is not that common, or not the most common of side effects. But this is a very uninformed guess. I just wondered if anyone out there had had something similar, and in particular if anyone had had or had performed surgical interventions to repair the sclera. Maybe even in cases unrelated to radiotherapy.

Thank you for reading and sharing information.

[alegz]

Dear Dr. Oyakawa,

Thank you for your response. Do you know if that type of side effect is common as a result of brachytherapy? And what kind of surgery does one undergo for scleral thinning?

Thank you.

[Ray T Oyakawa, MD]

There is surgery for scleral thinning used in progressive myopia.  However, for now it should just be monitored by your doctor.

Dr. O.