Retinal Pigment Epithelial Adenoma: Initial Treatment Outcomes following Episcleral Brachytherapy

Alaa E Fayed; Islam Y Swaify; Ayman M Khattab; Tamer A Macky; Dina H Hassanein; Shaymaa H Salah; Abdussalam M Abdullatif; Alia M Noureldine; Mariam R Fadel; Youssef A H Helmy; Ayman G Elnahry; Yasmine A Meqdad; Yagmur S Yesiltas; Arun D Singh; Hany Hamza

doi:10.1159/000536127

Retinal Pigment Epithelial Adenoma: Initial Treatment Outcomes following Episcleral Brachytherapy

Ocul Oncol Pathol. 2024 Apr;10(1):9-14. doi: 10.1159/000536127. Epub 2024 Jan 16.

Authors

Alaa E Fayed^{1

2}, Islam Y Swaify¹, Ayman M Khattab¹, Tamer A Macky¹, Dina H Hassanein¹, Shaymaa H Salah¹, Abdussalam M Abdullatif¹, Alia M Noureldine¹, Mariam R Fadel¹, Youssef A H Helmy¹, Ayman G Elnahry^{1

3}, Yasmine A Meqdad¹, Yagmur S Yesiltas^{4

5}, Arun D Singh^{4

5}, Hany Hamza¹

Affiliations

¹ Department of Ophthalmology, Cairo University Ocular Oncology Service, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
² Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
³ Division of Epidemiology and Clinical Applications, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
⁴ Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland, OH, USA.
⁵ Anatomic Pathology Cleveland Clinic, Cleveland, OH, USA.

Abstract

Introduction: We aim to explore the safety and efficacy of episcleral brachytherapy as a primary management option for eyes with retinal pigment epithelial (RPE) adenoma.

Methods: Retrospective chart review of the demographic, clinical, ancillary, and postoperative outcome data of patients with RPE adenoma in 2 tertiary referral centers. Tumor regression, final visual acuity, and complications were assessed.

Results: Five patients (3 females and 2 males) were included. Four of the 5 eyes had peripheral and mid-peripheral lesions, while one tumor was juxtapapillary. Three eyes were treated with ruthenium-106 (100 Gray), and 2 received iodine-125 episcleral plaques (85 Gray). All eyes showed clinical and imaging-based evidence of regression. Four eyes had stable or improved visual acuity, while 1 eye exhibited one line loss of visual acuity due to radiation retinopathy. Local recurrence was not observed in any eye over a median follow-up of 24 (range 6-112) months.

Conclusions: Episcleral brachytherapy is an effective management option for select cases of RPE adenoma that is capable of achieving tumor regression while maintaining favorable visual acuity. The initial safety profile of brachytherapy is good without significant vision-compromising complications.

Keywords: Adenoma; Brachytherapy; Episclera; Radiotherapy; Retinal pigment epithelium.

Grants and funding

This work was supported by a Research to Prevent Blindness Challenge Grant, Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine. The sponsor or funding organization had no role in the design or conduct of this research.