Brachytherapy remains a viable alternative to surgery, enucleation in ciliary body melanoma

Can J Ophthalmol. 2009;44(4):395-400.

Brachytherapy with a single radioactive isotope effectively reverses ciliary body tumor growth with generally manageable complications, offering a reasonable alternative to enucleation and other surgical interventions.

"Iodine-125 brachytherapy offers acceptable rates of tumor control, eye retention and survival, comparable to other forms of radiotherapy," according to a retrospective review of 42 patients. "The rates of radiation-related ocular morbidity were lower than those reported with charged particle radiotherapy and comparable to brachytherapy irradiation with other radioactive isotopes."

At the time of diagnosis, more than half of patients were asymptomatic: 23 patients (55%) had their tumor discovered during routine examination. In 13 patients (33%), flashes or floaters were the primary presenting symptom. Blurring of vision was reported in two patients, peripheral vision loss in two, and pain or redness in two. Median visual acuity at time of presentation was 20/40 and ranged from 20/20 to 20/200.

Median tumor thickness was reduced from 5.2 mm at baseline to 3.3 mm after brachytherapy after a median 43 months of follow-up. Radiation-induced cataracts developed in 55% of patients, radiation retinopathy in 24%, neovascular glaucoma in 15%, exudative retinal detachment in 8% and pigmentary glaucoma in 4%. One patient developed tumor recurrence, two patients developed liver metastasis, and three patients required enucleation.