USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, CA, USA.
The Vision Center, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Indian J Ophthalmol. 2024 Jun 1;72(6):912-915. doi: 10.4103/IJO.IJO_824_23. Epub 2024 Jan 8.
Surgical placement of eye plaque brachytherapy (EPB) is the standard of care for the treatment of uveal melanomas, including iris/iridociliary melanomas. However, unique challenges exist in anterior EPB placement. Here, we describe a surgical technique for anterior EPB placement when placement requires plaque positioning onto the cornea. Blunt conjunctival peritomy exposes the sclera overlying the tumor. A "dummy" plaque is placed, with positioning confirmed by direct visualization. The amniotic membrane is draped across the cornea and anchored with the eyelet sutures, the plaque is placed overlying the membrane, the conjunctiva is closed over the plaque, and a temporary tarsorrhaphy is performed. One week later, the conjunctival incision is reopened for plaque/amniotic membrane removal. This technique was employed in the treatment of 12 iris/iridociliary melanomas at our institution, with no instances of corneal damage. In placing an anterior plaque, employing this technique allows appropriate cancer treatment while optimizing patient comfort and corneal integrity.
眼斑近距离放射治疗（EPB）的手术植入是葡萄膜黑色素瘤（包括虹膜/睫状体黑色素瘤）治疗的标准护理。然而，在前部 EPB 植入中存在独特的挑战。在这里，我们描述了一种当植入物需要将斑块定位到角膜上时进行前 EPB 植入的手术技术。钝性结膜切开术暴露肿瘤上方的巩膜。放置“假”斑块，并通过直接可视化确认定位。羊膜横跨角膜铺开，并通过眼环缝线固定，将斑块置于膜上，结膜缝合在斑块上，并进行临时睑裂缝合。一周后，重新打开结膜切口以取出斑块/羊膜。我们机构在治疗 12 例虹膜/睫状体黑色素瘤时采用了这种技术，没有出现角膜损伤的情况。在植入前斑块时，采用这种技术可以在优化患者舒适度和角膜完整性的同时进行适当的癌症治疗。
