Abstract

Background: While episcleral brachytherapy is an effective treatment for uveal melanoma, its long-term complications have primarily focused on intraocular structures. Eyelid disorders following brachytherapy are rarely reported despite potential complications related to the plaque surgery. This retrospective study aimed to assess the prevalence, characteristics, and risk factors for acquired ipsilateral eyelid disorders (IEDs) after ocular brachytherapy.

Design: A retrospective clinical cohort study was conducted on patients who underwent episcleral brachytherapy at a single tertiary center between 2009 and 2023. Data collected included demographic variables, tumor characteristics, plaque type, surgical details, and presence of postoperative IEDs. The primary outcome was the association between brachytherapy and acquired IEDs.

Results: A total of 191 patients were included, 101 females (52.9%) mean age 63.4±14.2 years. All tumors were malignant melanoma: choroidal (n = 156, 81.7%), ciliary body (n = 27, 14.1%), iris (n = 7, 3.7%), and anterior segment (n = 1, 0.5%). Isotopes used included Iodine-125 (n = 150, 78.5%) and Ruthenium-106 (n = 41, 21.5%). IEDs developed in 40 cases (20.9%), predominantly affecting the upper eyelid. Ptosis was the most common finding (n = 35, 87.5%), followed by trichiasis (n = 1, 2.5%), ectropion (n = 1, 2.5%), and benign eyelid lesions (n = 3, 7.5%). Ptosis was significantly associated with anterior tumor location (p = 0.03), iodine isotope (p = 0.01), and female gender (p = 0.04). On multivariate logistic regression analysis, iodine-125 use (OR 5.38, 95% CI 1.21-23.88; p = 0.027) and anterior tumor location (OR 2.40, 95% CI 1.01-5.71; p = 0.048) remained independently associated with postoperative ptosis, whereas female gender did not retain statistical significance. No association was found with age, plaque diameter, radiation dose, laterality, muscle manipulation, or tarsorrhaphy.

Conclusion: Acquired eyelid disorders, particularly upper eyelid ptosis, are a relatively common and underrecognized complication following episcleral brachytherapy. Increased awareness of these potential sequelae and timely referral to oculoplastic specialists are advised.