All for flow.

Plaque brachytherapy offers an organ preservation treatment approach to uveal melanoma. Unfortunately it doesn’t always offer vision preservation. Wills Eye Hospital wants to change that. Here's a retrospective analysis of over 1100 eyes (this isn’t the Wills People Hospital, after all) treated for uveal melanoma with not only plaque brachytherapy but also “prophylactic” intravitreal bevacizumab at the time of plaque removal plus q4 months x 2 years. Bev here was used off-label with the theory it could halt ischemia-driven VEGF, a major player in the development of radiation maculopathy. At 2 and 3 years out these patients achieved an absolute decrease of approximately 10% in rates of maculopathy when compared to 117 eyes treated with plaque brachytherapy in the same era without prophylactic bev. More importantly, visual acuity was significantly better at all measured time points. To bring it home, this interactive nomogram can help predict visual outcomes for your next treated patient. TBL: Just when you think the end of the bev era may be in sight, it finds a promising new indication. | Shields, JAMA Opthlaml 2019