This video demonstrates successful eyeball-preserving management of a large choroidal melanoma using partial lamellar sclerouvectomy (PLSU) with ruthenium 106 plaque brachytherapy. A 48-year-old woman with a past history of asthma visited the clinic with a chief complaint of gradual right-eye vision loss at the nasal side. A mushroom-shaped, dark-pigmented choroidal mass was noted on fundus exam. Tumor size was 17.12 mm (basal diameter) × 14.21 mm (apical height) on orbital magnetic resonance imaging, with no evidence suggesting distant metastasis. For tumor resection with preservation of the eyeball, PLSU was performed with simultaneous ¹⁰⁶Ru plaque brachytherapy. Additional pars plana vitrectomy, cataract surgery, silicone oil injection, and intravitreal methotrexate injection were performed, with intravitreal bevacizumab injection every 2 months. The patient is in stable clinical condition with no sign of tumor recurrence or ocular complications at postoperative 1 year. PLSU with ¹⁰⁶Ru plaque brachytherapy is a useful eyeball-preserving treatment strategy even for large choroidal melanomas with apical height exceeding 14 mm.

Financial Disclosures: Drs. Min Kim, Seung Min Lee, and Hansang Lee disclose no financial relationships.