Brachytherapy for Ocular Tumors, Including Choroidal Melanoma
Ocular brachytherapy is a highly effective and eye-sparing treatment for certain intraocular tumors, including choroidal melanoma—the most common primary malignant tumor of the eye in adults. By placing a small radioactive plaque on the sclera overlying the tumor, high doses can be delivered directly to the lesion while preserving surrounding healthy ocular structures.
Choroidal melanoma treatment with plaque brachytherapy has shown excellent long-term local control rates, often exceeding 90%, with the majority of patients retaining functional vision. Isotopes such as iodine-125, ruthenium-106, or palladium-103 are selected based on tumor size, location, and desired dose distribution.
Advancements in ocular imaging, including optical coherence tomography (OCT) and high-resolution ultrasound, have improved tumor delineation, enabling more accurate plaque placement. Computer-assisted planning software further optimizes plaque positioning, ensuring the tumor receives the prescribed dose while minimizing exposure to the optic nerve and macula.
One of the key benefits of ocular brachytherapy is its minimally invasive nature compared to enucleation (eye removal), which was historically the standard for larger tumors. However, side effects such as radiation retinopathy or optic neuropathy remain challenges, prompting ongoing research into protective strategies and better dose modeling.
As treatment techniques advance, ocular brachytherapy continues to be a gold standard for eye preservation in appropriately selected patients, with global adoption supported by favorable clinical outcomes.