Vision-Saving Procedure May Extend Survival in Uveal Melanoma, UCLA Study Suggests

A UCLA-led study published in Cancers reports that a surgical approach originally devised to preserve vision during treatment of uveal melanoma might also reduce metastasis and improve survival. The findings may influence future standards of care in this rare intraocular cancer.

Study Design and Patient Cohort

The research followed 37 patients diagnosed with uveal melanoma over a median period exceeding four years. Most received plaque brachytherapy, a form of targeted radiation, combined with a vitrectomy plus silicone oil infusion. The latter technique temporarily replaces the eye’s natural vitreous with silicone oil, shielding healthy tissues from radiation while allowing full-dose treatment to the tumor.

Of the 37 patients:

       • 27 underwent brachytherapy with vitrectomy + silicone oil

       • 7 received brachytherapy alone

       • 3 underwent enucleation (removal of the eye)

During follow-up:

       • Over 80% remained free of metastasis

       • No treated eyes experienced tumor recurrence

       • 6 patients (16%) developed metastatic disease

       • 1 patient died from the disease

These results contrast with historical data, which suggest a ~30% metastasis rate over five years and poor survival after metastatic spread.

Unexpected Survival Benefits Beyond Vision Preservation

“We know that this unique surgical technique clearly saves vision. However, we did not expect the technique to alter metastasis and mortality,” said Dr. Tara McCannel, senior author and director of the Ophthalmic Oncology Center at UCLA. “Anything that improves survival in uveal melanoma is a game-changer.”

The research team also performed stratified analyses:

       • Patients deemed “high risk” via genetic markers still showed unexpectedly low metastasis and mortality.

       • Traditional predictors like tumor size and stage were not consistent determinants of metastatic spread in this cohort, some small tumors metastasized, others large ones did not.

       • Current genetic risk models were better at identifying low-risk patients than reliably predicting high-risk outcomes in this context.

Implications and Future Directions

The authors suggest that combining plaque brachytherapy with vitrectomy and silicone oil may offer dual benefits: preserving vision and improving systemic outcomes. However, they caution that further research is required to disentangle which factors, surgical technique, radiation delivery modulation, or patient selection, drive these favorable results.

They also note the procedural complexity involved, calling for expanded training in ocular oncology and vitreoretinal surgery to facilitate broader adoption of this approach.

Reference:

Axel Rivas et al, Unexpectedly Low Rate of Metastasis and Death Among Patients Treated for Uveal Melanoma with Brachytherapy, Vitrectomy, and Silicone Oil, Cancers (2025). DOI: 10.3390/cancers17162683