Plaque Brachytherapy for Eye Tumors: How It Works, Results and Recovery

Plaque brachytherapy is the standard way to treat most melanomas inside the eye without removing the eye. A small, slightly curved disc — the plaque — carries radioactive seeds on its inner surface. In a short operation it is stitched to the outer wall of the eye over the tumor; it stays there for several days while it delivers a carefully calculated dose, and is then removed in a second short operation. "Brachy" is Greek for "short": the source sits right against the tumor, so the dose falls away quickly in the healthy tissue around it.

This page explains who eye plaque radiotherapy suits, how it is carried out, what results and side effects to expect, and how recovery and travel fit around it.

What is plaque brachytherapy and how does it work?

The plaque is a thin metal disc shaped like a shallow cup to follow the curve of the eye. The seeds sit on its eye-facing side, and the metal backing shields the tissues outside the eye. Round plaques suit most tumors; notched plaques fit around the optic nerve, and curved designs are used near the ciliary body, the ring of tissue behind the iris.

The dose is prescribed to the tumor's apex (its highest point), so the base receives more. Nearby structures such as the macula (the center of sharp vision) and the optic nerve may also receive a substantial dose, which largely decides the long-term effect on sight. The radiation stops tumor cells from dividing: a treated melanoma usually shrinks slowly over months, and one that simply stops growing is also considered controlled.

Which isotopes are used?

Thickness limits differ between centers, and the tumor's position also influences the choice. In a Dublin series, tumor control was almost identical with ruthenium-106 (96.0%) and iodine-125 (95.8%).

Who is plaque brachytherapy for?

• Uveal melanoma: most melanomas of the choroid and ciliary body — small tumors that are growing or have high-risk features, medium tumors, and selected large tumors up to about 12 mm thick — and some iris melanomas. See uveal melanoma for sizing and staging, and choroidal nevus for small lesions that are usually watched first.
• Retinoblastoma: a single medium-sized tumor, often toward the front of the retina, or a tumor that returns after chemotherapy, as part of a wider plan described on the retinoblastoma page.
• Other tumors: a solitary metastasis in the choroid, larger peripheral retinal hemangioblastomas and vasoproliferative tumors, and choroidal hemangioma when light-based treatment is unsuitable or has not worked.

A plaque is generally unsuitable for very large tumors, tumors invading the optic nerve, extensive ciliary body or iris involvement, or an eye that is already blind and painful; these are usually treated by removal of the eye. Tumors touching the optic nerve are harder to control with a plaque — in a Dutch series of 719 patients, local failure was 20% for these juxtapapillary tumors versus 6% for others — and proton beam therapy is often considered for them.

How is plaque brachytherapy planned and carried out?

Plaque brachytherapy is planned and delivered together with radiation oncology and medical physics. A typical sequence:

1. Diagnosis and measurements. Examination, wide-field photographs, ultrasound and optical coherence tomography (OCT) give the key measurements: tumor thickness, base diameter, and distance to the optic nerve and macula. Liver imaging checks for spread, which is found at diagnosis in only about 2–3% of patients. See how eye tumors are diagnosed.
2. Physics planning. The ocular oncologist, radiation oncologist and medical physicist choose the isotope and plaque. The physicist calculates the dose distribution (dosimetry) and how long the plaque must stay on the eye to deliver the prescribed dose to the tumor apex.
3. Placing the plaque. Under anesthesia, the membrane over the white of the eye is opened, the tumor's edges are marked on the eye wall, and the plaque is stitched over them; an eye muscle is sometimes moved temporarily. A fine-needle biopsy for genetic testing can be taken during the same operation.
4. Days with the plaque in place. Usually several days — commonly about 3 to 7, depending on the calculated dose rate. The eye is covered and may feel scratchy and swollen, and radiation-protection rules apply.
5. Removing the plaque. A second short operation. From that moment, no radioactive material remains in your body.
6. Follow-up. Photographs, ultrasound and OCT every few months at first, then less often, to confirm the response and catch radiation effects early; body scans follow the tumor's risk group, as explained under follow-up after eye melanoma.

What results can you expect?

Survival. The Collaborative Ocular Melanoma Study (COMS) randomly assigned 1,317 patients with medium-sized choroidal melanoma to an iodine-125 plaque or to enucleation (removal of the eye). At 12 years, deaths from any cause were 43% after plaque and 41% after enucleation, and deaths from melanoma spread were 21% and 17%, a difference that was not statistically significant (a 2025 re-analysis noted that very small differences could not be excluded). Long-term survival depends mainly on the tumor's size and genetic profile (see prognosis).

Tumor control and the eye. In the Dublin series (mean follow-up 77 months), tumor control was about 96% and 94–96% of eyes were kept; in the Dutch series, 5-year control was 92% and eye retention 95%. After plaque treatment of small melanomas at Wills Eye Hospital, tumors recurred in 7% by 5 years and 11% by 10 years. Across studies, about 5–10% of irradiated eyes are eventually removed because of recurrence or complications.

Vision. In COMS, 49% of patients had lost 6 or more lines on the eye chart by 3 years. In the Dutch series, 47% had no functional visual impairment (vision of 0.5, about 20/40, or better) at 5 years, but 75% of those with tumors near the center of vision fell below that level.

What are the side effects of plaque brachytherapy?

In the first weeks the eye is usually red, swollen and scratchy, and vision may be blurred; if an eye muscle was moved, double vision can occur. These surgical effects usually settle as the eye heals. Months to years later, radiation can affect the tissues near the tumor. Reported frequencies vary with tumor size, position, dose and how closely the eye is examined:

Dryness and irritation of the eye surface can also occur; lash loss and dry eye are described mainly after proton beam treatment of tumors at the front of the eye.

Radiation retinopathy usually appears 6 months to 3 years after treatment (reported from 1 month to 15 years). It is more likely with tumors thicker than about 4 mm, tumors near the macula or optic nerve, higher doses to those structures, diabetes, high blood pressure, younger age, and chemotherapy given at the same time.

How are radiation side effects treated?

OCT scans at follow-up visits can show macular swelling before you notice any change, so treatment can start early:

• Anti-VEGF injections (bevacizumab, ranibizumab or aflibercept) block VEGF, a signal from oxygen-starved retina that drives leakage and abnormal vessels. They are given into the eye after numbing drops, usually as a repeated course.
• Steroids, as a triamcinolone injection or a slow-release dexamethasone implant, reduce macular swelling.
• Laser to retina that has lost its blood supply can make abnormal vessels regress, reported in about 64–66% of treated eyes.
• Prevention: in a 2009 randomized trial, a steroid injection around the eye at plaque placement reduced macular swelling at 18 months. Some centers give regular preventive anti-VEGF injections in the first years; reports suggest less maculopathy, although without randomized comparison.
• Other complications: cataract is removed once the tumor is controlled (see cataract surgery after eye tumor treatment); neovascular glaucoma is treated with injections, laser, drops or surgery; radiation optic neuropathy is harder to treat. A blind, painful eye can be removed to relieve the pain.

What is recovery like after plaque brachytherapy?

After removal, the surgical redness and swelling settle over the following weeks. You will usually use eye drops for a period, avoid rubbing the eye, and be told when to return to work, exercise and swimming. The tumor's response is judged over months: at each visit, photographs and ultrasound measurements are compared with the baseline, and a tumor that shrinks or stops growing is responding.

Radiation safety for family and visitors

While the plaque is on the eye, most of its radiation is absorbed inside the eye and by the metal backing, but a small amount reaches people nearby — more with iodine-125, whose gamma rays travel farther than the beta radiation of ruthenium-106. Depending on the isotope and national rules, you may stay in hospital or at home. Typical precautions are to keep a distance from pregnant women and young children and to avoid long periods of close contact; the radiation safety team explains what applies to you. Once the plaque is removed, nothing radioactive remains in your body, and you can hold children and grandchildren without restriction.

Can I fly after plaque brachytherapy?

Travel home is planned after the plaque has been removed and the eye examined. Aviation guidance mainly concerns gas bubbles in the eye, which expand at altitude: the UK Civil Aviation Authority advises waiting about 2 weeks after SF6 gas and 6 weeks after C3F8 gas, and about 1 week after other procedures inside the eye. Plaque surgery works on the outer wall of the eye without a gas bubble, so flying is usually possible soon after removal; if a biopsy was taken from inside the eye, the 1-week interval may be advised. Later follow-up can often be shared, with scans done closer to home and reviewed remotely.

What are the alternatives to plaque brachytherapy?

• Proton beam therapy suits large tumors and tumors next to the optic nerve or macula, but only a few dozen centers worldwide offer it.
• Stereotactic radiosurgery or radiotherapy (Gamma Knife, CyberKnife, LINAC) focuses converging beams on the tumor without surgery on the eye wall. Both are compared on the page on proton therapy and stereotactic radiotherapy.
• Light and heat treatments — photodynamic therapy or transpupillary thermotherapy — for selected small tumors; thermotherapy is now used mainly with a plaque because tumors often recur after it alone.
• Local resection of the tumor, for selected tumors at a small number of centers.
• Enucleation, with an orbital implant and later a custom-made prosthesis.

Plaque brachytherapy with Prof. Türkoğlu in Antalya

Prof. Türkoğlu, a Professor of Ophthalmology and ocular oncologist with more than 20 years in ophthalmology, examines the eye, reviews the imaging and measurements, and explains whether a plaque, another form of radiation or a different approach is most suitable for your tumor. Because a plaque requires radioactive sources and specialized facilities, it is planned and delivered together with radiation oncology and medical physics teams, who handle the isotope, dose calculation and radiation protection. She then follows the eye for tumor response and radiation effects.

If you live abroad, a remote second opinion based on your photographs, ultrasound and scan reports can show whether a plaque is likely to be suitable before you travel. What drives the cost is explained under eye cancer treatment costs in Turkey.