Vision-Saving Surgical Technique Linked to Survival Benefit in Uveal Melanoma

A retrospective study of patients with uveal melanoma showed that the addition of vitrectomy and silicone to plaque brachytherapy may delay metastases and prolong survival in addition to its intended benefit of protecting the patient’s vision.^1,2

Previous research has shown that the treatment technique, which was developed at UCLA, reduces vision loss in patients with uveal melanoma by shielding healthy eye tissue from the radiation delivered by the plaque brachytherapy.

The retrospective analysis, which was published in the journal Cancer, included 37 patients with uveal melanoma, nearly three-fourths (73%) of whom received plaque brachytherapy with vitrectomy and silicone oil. Of the remaining patients, nineteen percent underwent brachytherapy alone and 8% received enucleation.

At a median follow-up of 4.0 years, the 5-year distant metastasis-free survival (DMFS) rate was 80%, which the study authors categorized as “unexpectedly low.” The median DMFS had not yet been reached. Eventually, 6 (16.2%) patients developed metastatic disease, although no patients experienced intraocular treatment failure. Regarding overall survival, the authors wrote, “Overall survival at 5 years remained at 100%. Only one patient died from metastatic disease prior to the date of analysis.”

Cytogenetic and genomic indictors of low risk for metastasis (disomy 3 and class 1 gene expression profile [GEP]) were accurate with a higher than 90% negative predictive value; however, most patients with high risk factors (monosomy 3 and class 2 GEP) did not develop metastases, leading the study authors to call for more accurate methods of testing.

“Everything about uveal melanoma has always been painted with limited hope, with patients expected to lose vision and eventually die once the cancer spreads,” Tara McCannel, MD, PhD, director of the Ophthalmic Oncology Center at the UCLA Stein Eye Institute, an investigator in the UCLA Health Jonsson Comprehensive Cancer Center, and senior author of the study, stated in a news release. “We know that this unique surgical technique clearly saves vision. However, we did not expect the technique to alter metastasis and mortality. And anything that improves survival in uveal melanoma is a game-changer.”

“Our study shows that combining plaque brachytherapy with vitrectomy and silicone oil not only helps patients preserve their vision but may also improve survival,” McCannel added. “Since most centers still rely on plaque brachytherapy alone to treat uveal melanoma, these findings underscore the need to adopt our vitrectomy with silicone oil approach.”

Uveal Melanoma Study Background and Next Steps

Through a search of electronic health records from the IKnowMed clinical oncology database (McKesson, Houston, TX, USA) the researchers identified 37 patients with uveal melanoma who received treatment from 1 vitreoretinal surgical oncologist and were subsequently monitored by 1 medical oncologist in a community setting.

The median patient age was 59 (range, 24-84). Seventy percent of patients were male and 30% were female. Most (90%) patients were White-Not Hispanic. The median tumor height was 4.06 mm (range 1.14-14.92) and the median maximal basal diameter was 13.0 mm (range, 6.88-21.62). Regarding tumor stage, 40.5% of patients had stage T1 tumors, 24.3% had stage T2, 21.6% had stage T3, and 13.5% had stage T4.

In their conclusion, the authors noted that further analysis is needed to interpret the full significance of their results.

“Although we observed a low metastatic rate in patients treated with plaque brachytherapy, vitrectomy, and silicone oil placement, it is not clear how these procedures may have resulted in improved outcomes. Further laboratory and more rigorous clinical investigations are needed to evaluate whether vitrectomy and silicone oil exert tumoricidal or immunomodulatory effects in a manner that impacts systemic progression or whether more effective brachytherapy delivery alone is responsible for the observed outcome.”

REFERENCES:

1. Heady D.Vision-saving eye surgery may also improve survival in patients with rare eye cancer, study finds. UCLA Health News & Insights. September 16, 2025. Accessed September 18, 2025.

2. Rivas A, Samlowski W, McCannel TA. Unexpectedly low rate of metastasis and death among patients treated for uveal melanoma with brachytherapy, vitrectomy, and silicone oil. Cancers. 2025;17(16):2683. doi:10.3390/cancers17162683