Ruthenium brachytherapy for iris melanoma

Purpose:
The study aimed to review the long-term outcomes of ruthenium brachytherapy for iris and iridociliary melanoma.

Material and methods:
Medical records of patients who underwent ruthenium plaque treatment for iris and iridociliary melanoma at the Department of Ophthalmology, Poznań University of Medical Sciences, between 1999 and 2021 were retrospectively reviewed.

Results:
We identified 24 patients, including 17 women and 7 men, with a median age of 61.5 years (range, 35-84 years). Median observation time before treatment was 3 months (range, 0-68 months). Nineteen (79%) patients received a treatment with 20 mm CCB plaque, 5 (21%) with 15 mm CCA plaque and 2 (8%) patients received total irradiation to the entire iridocorneal angle. Median follow-up was 67.5 months (range, 24-265 months). We noted one (4%) recurrence managed by irradiating the anterior segment. Twelve (50%) patients developed post-operative cataracts in a median time of 38 months following treatment, 5 (21%) required topical medications to control intraocular pressure, and one (4%) developed chronic macular edema (CME) that was managed with anti-VEGF therapy. Final visual acuity between 1.0 and 0.5 was observed for 16 (67%) patients, between 0.49-0.1 for 5 (21%) patients, and below 0.09 for 3 (12%) patients. Nine (37%) patients maintained final visual acuity stable; in 4 (17%) patients, it dropped more than 3 lines, and improved in 6 (25%) patients.

Conclusions:
Ruthenium brachytherapy with standard applicators is an effective and safe way of treatment for iris and iridociliary melanoma. We observed no significant post-operative complications in a long-term observation.