Anterior plaque brachytherapy placement for treatment of iris and iridociliary melanomas - Surgical procedure and institutional experience

• Published in: Indian journal of ophthalmology 2024-06, Vol.72 (6), p.912-915
• Main Authors: Pike, Sarah, Engelhard, Stephanie B, Greig, Luciano Custo, Woods, Kaley, Jennelle, Richard L, Berry, Jesse L
• Format: Article
• Language: English
• Subjects: Amniotic membrane; anterior plaque brachytherapy; anterior plaque placement; Brachytherapy; Brachytherapy - methods; Cancer therapies; Ciliary Body - surgery; Conjunctiva; Cornea; Female; Humans; iridociliary melanoma; Iris; iris melanoma; Iris Neoplasms - diagnosis; Iris Neoplasms - radiotherapy; Iris Neoplasms - surgery; Male; Melanoma; Melanoma - diagnosis; Melanoma - radiotherapy; Melanoma - surgery; Middle Aged; Ophthalmologic Surgical Procedures - methods; Radiation therapy; Surgical Technique; technique; Uveal Neoplasms - diagnosis; Uveal Neoplasms - radiotherapy; Uveal Neoplasms - surgery
• ISSN: 0301-4738; 1998-3689; 1998-3689
• DOI: 10.4103/IJO.IJO_824_23

Surgical placement of eye plaque brachytherapy (EPB) is the standard of care for the treatment of uveal melanomas, including iris/iridociliary melanomas. However, unique challenges exist in anterior EPB placement. Here, we describe a surgical technique for anterior EPB placement when placement requires plaque positioning onto the cornea. Blunt conjunctival peritomy exposes the sclera overlying the tumor. A "dummy" plaque is placed, with positioning confirmed by direct visualization. The amniotic membrane is draped across the cornea and anchored with the eyelet sutures, the plaque is placed overlying the membrane, the conjunctiva is closed over the plaque, and a temporary tarsorrhaphy is performed. One week later, the conjunctival incision is reopened for plaque/amniotic membrane removal. This technique was employed in the treatment of 12 iris/iridociliary melanomas at our institution, with no instances of corneal damage. In placing an anterior plaque, employing this technique allows appropriate cancer treatment while optimizing patient comfort and corneal integrity.