Question explored with the scientific record
Conversation so far
- 1 treatment for ocular melanoma eye tumour
- 2 what are the chances of cancer spreading to liver after radioactive seedd sewn onto eye
- 3 will radioactive seed treatment save sight?
Answered on this page ↓
will radioactive seed treatment save sight?
The short version: the seed treatment saves the eye far more reliably than it saves the vision, and the vision loss is the price of the radiation, not a failure of the technique.
Plaque brachytherapy keeps the tumor controlled in most eyes. In a 190-patient iodine-125 series, 5-year local control was 91% [4]. In a 42-patient ciliary-body series, 93% kept the eye [6]. But vision is a different story. In one comparison, only 31% of plaque-treated eyes ended at 20/200 or better, versus 53% after surgical removal of the tumor [1]. In another, 33% of iodine-125 eyes versus 60% of ruthenium eyes reached 20/200 or better [3]. Higher radiation dose tracked with more vision loss without improving tumor control [4].
| Series | Eyes | Vision 20/200 or better | Eye kept |
|---|---|---|---|
| I-125 vs surgery [1] | plaque arm | 31% | - |
| I-125 vs Ru-106 [3] | 15 I-125 | 33% | - |
| Eye Physics plaques [8] | 82 | - | 97.6% |
| Ciliary body I-125 [6] | 42 | - | 93% |
The damage is mechanical and predictable: radiation thins the retina and destroys the light-sensing layer inside the treated zone [5]. Radiation retinopathy and optic nerve damage are the documented complications, and they can be treated with anti-VEGF injections or steroids, with variable and temporary results [7][2]. These are mostly retrospective case series, not randomized trials, so the numbers are soft.
My call: plaque brachytherapy is good at saving the eye and mediocre at saving sharp vision, and the outcome depends heavily on where the tumor sits relative to the center of the retina. Confidence: moderate.
Sources used 8
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Transscleral resection without hypotensive anaesthesia vs iodine-125 plaque brachytherapy in the treatment of choroidal melanoma
This study compares the outcomes of transscleral resection without hypotensive anaesthesia (TSRWH) and iodine-125 plaque brachytherapy (IBT) in treating choroidal melanoma, finding that TSRWH may offer better visual acuity preservation despite its technical challenges.
DOI: 10.1038/eye.2016.49 -
Antivascular Endothelial Growth Factor Bevacizumab for Radiation Optic Neuropathy: Secondary to Plaque Radiotherapy
This study evaluates the safety and efficacy of intravitreal bevacizumab for treating radiation optic neuropathy (RON) in 14 patients who developed RON after plaque radiotherapy for choroidal melanoma, finding that the treatment was generally well-tolerated and associated with i…
DOI: 10.1016/j.ijrobp.2010.11.075 -
<p>Comparison of Iodide-125 and Ruthenium-106 Brachytherapy in the Treatment of Choroidal Melanomas</p>
In this retrospective, non-randomized study, the authors compared 125I and 106Ru episcleral plaque brachytherapy for choroidal melanoma and found that iodine-125 provides comparable local tumor control and vision preservation to ruthenium-106, with potential superior tumor thick…
DOI: 10.2147/opth.s235265 -
Uveal Melanoma Treated With Iodine-125 Episcleral Plaque: An Analysis of Dose on Disease Control and Visual Outcomes
This retrospective study of 190 patients with uveal melanoma treated with iodine-125 plaque brachytherapy found that while increasing radiation doses correlated with greater visual acuity loss and radiation complications, they did not affect tumor control outcomes.
DOI: 10.1016/j.ijrobp.2014.01.026 -
Blue-Light Fundus Autofluorescence Imaging following Ruthenium-106 Brachytherapy for Choroidal Melanoma
After ruthenium-106 brachytherapy for choroidal melanoma, the irradiation field shows a characteristic FAF pattern—rim of increased FAF and FAF mottling—correlating with distinct OCT alterations including ellipsoid zone loss, retinal thinning, and RPE changes.
DOI: 10.1159/000504715 -
Management of ciliary body melanoma with iodine-125 plaque brachytherapy
A retrospective, nonrandomized case series evaluating presentation, management, and outcomes of 42 patients with ciliary body melanoma treated with iodine-125 plaque brachytherapy, showing high tumor control and eye preservation but notable radiation-related ocular morbidity.
DOI: 10.3129/i09-097 -
Current treatments and preventive strategies for radiation retinopathy
This article is a narrative review that surveys current and preventive strategies for radiation retinopathy, encompassing laser therapy, anti-VEGF and steroid treatments, photodynamic therapy, and preventive approaches, and discusses variable outcomes and the need for further ev…
DOI: 10.1097/ICU.0000000000000141 -
Outcomes of Choroidal Melanomas Treated With Eye Physics
This study reviews the outcomes of 82 patients treated for medium-sized choroidal melanoma using Eye Physics plaques and compares these results with the Collaborative Ocular Melanoma Study, finding favorable rates of local control and fewer adverse effects.
DOI: 10.1001/jamaophthalmol.2013.4422