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P. T. Finger; Finger's Slotted Eye Plaque Radiation Therapy for Juxtapapillary and Circumpapillary Choroidal Melanoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5240.
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To create a slotted plaque radiation therapy device for treatment of juxtapapillary and circumpapillary choroidal melanomas.
As a technical innovation, a 8-mm wide slotted eye plaques were constructed as to accommodate the orbital portion of the optic nerve. This study conforms to the declaration of Helsinki and the United States Health Insurance Portability and Privacy Act of 1996 (HIPPA). As proof of purpose, it was used for 3 patients with choroidal melanomas that encircled their optic disks (n = 2) or could not be treated with a standard notched eye-plaque (n = 1). Ultrasound c-scans were used to measure optic nerve sheath diameters prior to surgery. As the optic nerve sheath entered the plaque, the plaques posterior margin was able to extend beyond the optic disk. Radioactive seeds were affixed on either side of the slot (encircling the optic nerve) in order to treat both the tumor (within the slot), melanoma beneath the plaque, plus a posterior margin of normal appearing tissue. Intra-operative ultrasonographic localization was used to confirm proper plaque placement.
A slotted eye-plaque was created as to accommodate the orbital portion of optic nerve. Despite the gap created by the slot, pre-operative radiation dosimetry showed that all tumor-tissue received a minimum of 85 Gy. This slotted plaque design allowed the position of radioactive seeds and therefore the targeted zone to be shifted posterior to that allowed by plaque notching. With short-term follow-up, there has been no evidence of ocular ischemia, tumor growth or complications attributable to slotted plaque radiation therapy.
Slotted plaques can be used to cover and thereby prevent geographic miss of juxtapapillary and circumpapillary choroidal melanomas.
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