Outcome of Secondary Glaucoma in Eyes With Uveal Melanoma A Population-Based Analysis

Précis: Over 50% of eyes with uveal melanoma and secondary glaucoma with ≥20/400 vision retain that level through 5 years, and over 90% with <20/400 vision are pain-free. Over 90% avoid secondary enucleation for intractable glaucoma. Purpose: To report outcome of secondary glaucoma in uveal melanoma eyes mainly treated with brachytherapy. Patients and Methods: Of 186 consecutive patients with uveal melanoma and secondary glaucoma, 49 (26%) with ≥20/400 vision were assigned to therapeutic and 137 (74%) with <20/400 vision to palliative group. Glaucoma-related medications and procedures were recorded. Main outcome measures were best corrected visual acuity, pain, and enucleation. Results: The therapeutic group had thinner (median, 7.5 vs. 9.1 mm), more anterior tumors (median distance to disc and foveola, 10 vs. 3.5 mm and 12 vs. 3.6 mm, respectively; 29% vs. 11% iris melanomas) than the palliative group. The main mechanism of secondary glaucoma was angle invasion (45%) and neovascularization (71%), respectively. In the therapeutic group, 96% and 47% of eyes were managed with medication and cyclophotocoagulation, respectively, compared to 77% and 20% in the palliative one. At 1, 3, and 5 years, 60%, 69%, and 67% in the therapeutic group were normotensive (4–21 mmHg), 63%, 55%, and 58% preserved ≥20/400 vision, and 28%, 36%, and 46% also retained ≥20/60 vision, respectively. Low vision at patient level (3%, 4%, and 5%, respectively) was exceptional. In the palliative group, 84%, 92%, and 96% were free of pain, respectively, and cumulative incidence of enucleation for secondary glaucoma was 9% by 5 years. Conclusions: Most uveal melanoma eyes with secondary glaucoma and useful vision potential become normotensive with medication and cyclophotocoagulation and retain ≥20/400 vision. Most with less visual potential become pain-free without intensive medication and avoid enucleation.