Arun D Singh1, William J Dupps, Charles V Biscotti, John H Suh, Kira L Lathrop, John P Nairn, Helen Shih. 1. *Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, OH; †Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH; Departments of ‡Anatomic Pathology; and §Radiation Oncology, Cleveland Clinic, Cleveland, OH; ¶University of Pittsburgh School of Medicine/Ophthalmology and Swanson School of Engineering/Bioengineering; ∥Associates in Ophthalmology, Pittsburgh, PA; and **Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Abstract
PURPOSE: To report the outcome after limbal stem cell preservation during proton beam irradiation for diffuse iris melanoma. METHODS: This is a single-case report of diffuse iris melanoma that was managed with proton beam radiation (53 Gy), wherein preemptively harvested superior and inferior limbal stem cells before radiation were replaced after irradiation. Regeneration of the palisades of Vogt and the limbal stem cells was documented by an optical coherence tomography-based imaging protocol. RESULTS: At 24 months after radiation therapy, best-corrected visual acuity was 20/25. The cornea was clear without evidence of limbal stem cell dysfunction. Clinical examination (including gonioscopy and ultrasound biomicroscopy [UBM]) was indicative of local control, and systemic surveillance was negative for metastatic disease. At posttransplant (21 months), there were more palisade structures visible in both anterior and posterior regions of the superior and inferior limbus, and the linear presentation of the inferior palisades appears to have regenerated. CONCLUSIONS: Diffuse iris melanoma can be managed successfully with proton beam radiation while preserving corneal limbal stem cells by harvesting them before radiation and then replacing them after irradiation. Regeneration of the palisades of Vogt could be documented by an optical coherence tomography-based imaging protocol.
PURPOSE: To report the outcome after limbal stem cell preservation during proton beam irradiation for diffuse iris melanoma. METHODS: This is a single-case report of diffuse iris melanoma that was managed with proton beam radiation (53 Gy), wherein preemptively harvested superior and inferior limbal stem cells before radiation were replaced after irradiation. Regeneration of the palisades of Vogt and the limbal stem cells was documented by an optical coherence tomography-based imaging protocol. RESULTS: At 24 months after radiation therapy, best-corrected visual acuity was 20/25. The cornea was clear without evidence of limbal stem cell dysfunction. Clinical examination (including gonioscopy and ultrasound biomicroscopy [UBM]) was indicative of local control, and systemic surveillance was negative for metastatic disease. At posttransplant (21 months), there were more palisade structures visible in both anterior and posterior regions of the superior and inferior limbus, and the linear presentation of the inferior palisades appears to have regenerated. CONCLUSIONS: Diffuse iris melanoma can be managed successfully with proton beam radiation while preserving corneal limbal stem cells by harvesting them before radiation and then replacing them after irradiation. Regeneration of the palisades of Vogt could be documented by an optical coherence tomography-based imaging protocol.