Abstract

Uveal melanoma is the most common primary intraocular malignancy, primarily affecting the choroid, ciliary body, and iris. Radiotherapy is an important treatment modality for preserving vision and preventing metastasis in patients with uveal melanoma. However, despite its efficacy, radiotherapy is associated with a range of ocular complications that can significantly impact visual function and quality of life. This article provides a comprehensive review of the ocular complications of radiotherapy in uveal melanoma, including radiation retinopathy, cataract formation, neovascular glaucoma, optic neuropathy, and radiation-induced tumor recurrence. The underlying mechanisms, clinical manifestations, diagnostic approaches, and management strategies for these complications are discussed, highlighting the importance of multidisciplinary care and long-term follow-up to optimize patient outcomes. A poor visual outcome is mainly associated with the presence of radiation retinopathy and radiation optic neuropathy. Therapeutic options are available for the majority of complications with the notable exception of optic neuropathy. Reducing complication rates can be achieved by lowering the dose of radiation, with the use of eccentric, customized plaques and careful planning of the irradiation delivery in order to protect structures vital to vision and by associating radiation therapy with other methods with the aim of reducing tumor volume.