Neovascular glaucoma as a complication of proton therapy for uveal melanoma

I.E. Panova^1,2,3, E.M. Svistunova¹, N.A. Vorobyov^2,4, E.V. Samkovich¹, N.I. Martynova⁴, A.A. Bykhovsky¹ ¹Saint Petersburg Branch of the S. Fyodorov Eye Microsurgery Federal State Institution,&nbsp;&nbsp; St. Petersburg, Russian Federation ²St. Petersburg State University, St. Petersburg, Russian Federation ³North West State Medical University named after I.I. Mechnikov, St. Petersburg,&nbsp;&nbsp; Russian Federation ⁴Medical and Diagnostic Center of the International Institute of Biological Systems&nbsp;&nbsp; named after Berezin Sergei, St. Petersburg, Russian Federation <b>Aim: </b>to evaluate possible predictors of neovascular glaucoma (NVG) in patients with uveal melanoma (UM) after pencil-beam scanning proton therapy (PT). <b>Patients and Methods: </b>29 UM patients (30 eyes; age: 23–87 years) received a course of hypofractionated PT at a total dose of 49 Gy in 7 fractions (BED 0.6=620 Gy; EQD2=143 Gy). After the therapy, radiation-related complications developed in 26 patients at various times, and in some cases they affected multiple systems. Ocular hypertension was reported in 13 patients, and NVG developed in 9 of them. NVG predictors were evaluated in groups of NVG patients (Study Group/SG 1) and non-NVG ones (SG 2) with a ≥6-month follow-up (n=22) after the end of the PT course. <b>Results: the </b>NVG group demonstrated lower best corrected visual acuity (BCVA) and total visual field loss (along 8 meridians, in degrees) values, as well as pre-treatment Bruch's membrane rupture and more advanced stage of the disease significantly (p&lt;0.05) more often than the non-NVG group. <b>Conclusion:</b> the study revealed some possible predictors of neovascular glaucoma development that should be considered to select patients for pencil-beam scanning PT in terms of organ preservation UM treatment. Further study of the issue in a larger patient cohort and a longer follow-up will provide identification of additional risk factors for NVG and generation of a mathematical prediction model of the complication development. <b>Keywords: </b>choroidal melanoma, proton therapy, uveal melanoma, ocular oncology, neovascular glaucoma, radiation-related complications. <b>For citation:</b> Panova I.E., Svistunova E.M., Vorobyov N.A., Samkovich E.V., Martynova N.I., Bykhovsky A.A. Neovascular glaucoma as a complication of proton therapy for uveal melanoma. Russian Journal of Clinical Ophthalmology. 2024;24(4):185–192 (in Russ.). DOI: 10.32364/2311-7729-2024-24-4-4