Transscleral Plaque Brachytherapy and Choroidal Biopsy for Choroidal Melanoma

In this clinical video, Drs. Mohsin Ali, Wenlan Zhang and Miguel Materin perform a trans-scleral plaque brachytherapy and choroidal biopsy for a patient with choroidal malignant melanoma. They first separated the conjunctiva and tenon’s capsule in the superotemporal, inferotemporal and inferonasal quadrants. The inferior and lateral rectus muscles were then cleaned and sutured. After locating the tumor with transillumination, they positioned a dummy plaque directly over the melanoma, pre-marked the lugs and passed scleral sutures through these marked sites. This was followed by cutting a partial thickness scleral flap and obtaining biopsies for gene expression profiling and cytopathologic analyses. The biopsy site was treated with cryotherapy and washed before suturing. A I-125 radioactive plaque was then inserted into the inferotemporal quadrant and secured with previously set sutures. The plaque was removed 4 days later. After 4 months, the patient showed signs of tumor regression and no trace of systemic metastatic disease.

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