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This prospective study reveals that ocular proton therapy (OPT) in patients with uveal melanoma leads to significant decreases in corneal subbasal nerve plexus (SNP) parameters, including nerve fiber density, branch density, and fiber length, with only partial recovery after 12 months. Despite this structural nerve loss, corneal sensitivity remained unchanged, and patient-reported ocular symptoms showed limited correlation with nerve alterations.
Greater nerve loss correlated with larger treatment volumes and increased corneal irradiation. Patient-reported decline was limited to peripheral vision, while other visual function domains were largely unaffected.