Intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma

Am J Ophthalmol. 2000 Feb;129(2):199-204. doi: 10.1016/s0002-9394(99)00315-3.


Purpose: To report intraoperative echographic localization of iodine-125 episcleral plaque for brachytherapy of choroidal melanoma.

Methods: In a retrospective study, 117 eyes with medium-sized choroidal melanoma in 117 patients not participating in the Collaborative Ocular Melanoma Study underwent iodine-125 episcleral plaque radiotherapy with intraoperative echographic verification of plaque placement between January 1992 and December 1998 at the Bascom Palmer Eye Institute.

Results: After initial plaque placement using standard localization techniques, intraoperative echography demonstrated satisfactory tumor-plaque apposition in 76% of eyes (89 of 117). In the 28 eyes (28 of 117, 24%) that required repositioning of the plaque, the extent of misplacement was less than 1 mm in 10 eyes, 1.1 to 3.0 mm in six eyes, and greater than 3 mm in eight eyes. Two eyes had tilting of the plaque, and in two additional eyes, although the plaque covered all tumor margins, the centration was considered suboptimal. Repositioning was necessary in 1 eye with an anteriorly located tumor (1 of 13, 7.7%) and in 20 eyes with peripapillary or posterior pole tumors (20 of 67, 26.3%). Anteriorly located tumors required plaque repositioning significantly less frequently than did posteriorly located tumors (P = .041). Misalignment involved one tumor margin in 23 eyes and two margins in five eyes. The most commonly misaligned margins were the lateral (35%) and posterior margins (26%). In no case was an anterior marginal misalignment documented. At a mean follow-up of 37 months, no tumor-related death or metastatic disease was noted. Two of the 117 patients (1.7%) had local tumor recurrence and underwent enucleation.

Conclusions: Intraoperative echography is an effective adjunct for localization and confirmation of tumor-plaque relationship. This technique facilitates the identification and correction of suboptimal plaque placement at the time of surgery, potentially minimizing treatment failures.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Brachytherapy*
  • Choroid Neoplasms / diagnostic imaging*
  • Choroid Neoplasms / radiotherapy
  • Female
  • Humans
  • Intraoperative Care / methods
  • Iodine Radioisotopes / therapeutic use*
  • Male
  • Melanoma / diagnostic imaging*
  • Melanoma / radiotherapy
  • Middle Aged
  • Retrospective Studies
  • Ultrasonography


  • Iodine Radioisotopes