Amniotic Membrane Is Used To Protect The Cornea During Plaque Radiation Therapy

Amniotic Membrane Graft on the Cornea (Arrow) affixed beneath a Custom Gold Eye Plaque
Amniotic Membrane Graft on the Cornea (Arrow) affixed beneath a Custom Gold Eye Plaque

By Paul T. Finger, MD

Patients with melanomas of the iris and ciliary body are more and more commonly treated with plaque radiation therapy. This is because I found radiation to be less invasive and therefore safer than intraocular surgery. Plus, larger areas can be treated with radiation than can be safely removed. This has allowed for excellent local control (tumor destruction) and vision retention. Though many irradiated patients develop radiation cataracts, these can be removed (the same way as other cataracts) restoring excellent vision. At The New York Eye Cancer Center, almost no patients with anterior intraocular melanomas have developed sight-limiting radiation maculopathy or optic neuropathy.

However, in the past, there have been problems associated with placing the radioactive plaque onto the cornea. First, there were concerns about irradiating the cornea. Second, many patients found having a metal device sewn to their cornea for 4-7 days painful.

Dr. Finger has found the cornea tolerated the amount of radiation required to treat iris and ciliary body melanomas. It remained clear for the vast majority of patients. However, having a radiation plaque sewn to the cornea was an uncomfortable procedure.

In an effort to solve this problem, Dr. Finger discovered that a thin, transplanted amniotic membrane tissue could be placed between the gold radiation eye plaque and the cornea during treatment. He simply slides this tissue between the plaque and the cornea during implantation. It is removed 7 days later when the plaque is removed. This technique has made a huge difference – it improved patient comfort and does not affect the radiation treatment.

This note is linked to a You-Tube video demonstrating this new technique. It shows implantation of a plaque onto the cornea and eye wall.

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