Radiation plaque therapy is the most commonly used “eye-sparing” treatment for choroidal melanoma.
A radioactive plaque is a small, gold covered, dish-shaped device that contains a radioactive source. Standard low-energy radioactive eye-plaques contain rice-sized radiation seeds that emit low energy photons. The gold coat of the plaque helps to aim the radiation photons directly at the tumor and decrease radiation damage to surrounding tissues. As the cells die, the tumor shrinks, although it usually does not disappear entirely. Radiation plaque therapy may be recommended for choroidal melanomas or iris melanomas.
Eye plaques are custom made to the dimensions of the tumor, usually ranging in size from about 12 to 22 mm. in diameter (about the size of a quarter). Careful calculations determine how long the plaque must remain in place to give the tumor the proper amount of radiation.
What to Expect
Surgical placement of the plaque lasts about an hour and usually is performed under local anesthesia. During surgery, an incision is made in the conjunctiva and the radioactive plaque is sutured to the sclera on the outside of the eye and directly, over the tumor. The conjunctiva is then sewn back over the plaque. Patients remain in the hospital for about three to five days at which time the plaque is surgically removed.
Most patients have no problems associated with plaque surgery. As with any ocular surgery, there can be secondary complications such as retinal detachments, hemorrhages, or infections. There are also risks associated with anesthesia.
The effects of radiation on the tumor typically are first evident three months after treatment. Eventually, eye melanomas shrink to about 40% of their pretreatment size. After successful treatment, although the tumors rarely completely disappear, they are considered to be inactive.
After radioactive plaque treatment, many patients note some dryness and irritation of the eye. In some instances, eyelashes may be permanently lost. In rare instances, the outside layer of the eye (sclera) may become very thin. Occasionally, prolonged redness, irritation, or infection may occur. Some patients may experience double vision, which can last a few days or several months. Radiation plaque therapy may cause eventual blurring, dimming, or rarely a total loss of vision in the treated eye. Plaque radiation does not affect the vision in the other eye. The amount of vision loss depends on what your vision was before treatment, how close the tumor is to the area of central vision of the eye, and how sensitive your tissues are to radiation. Most people maintain some central vision, and almost all retain peripheral vision. Regular follow-up after treatment with radioactive plaque is important to monitor the tumor and treat potential complications of radiation therapy.
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