Radiation Plaque Therapy
In 1991, Dr. Finger discovered that palladium-103 radiation typically offered a better radiation distribution (within the eye) that the more commonly used iodine-125 radiation in ophthalmic plaques. Over the following 25 years, Dr. Finger has periodically published his experience with palladium-103 plaque therapy to treat intraocular melanoma. He has among the highest local tumor control, eye, and visual acuity retention rates when compared to other published studies/clinical centers. Vision retention means keeping your vision. These outcomes are related to careful treatment planning, selection of the best radiation source and a surgeon who has been carefully treating patients with ophthalmic radiation therapy for more than 30 years.
Finger-Tip Cryotherapy Applicators
Dr. Finger introduced the “Finger-tip” cryotherapy “freezing” applicators for treatment of malignant conjunctival and corneal tumors. Freezing is used to destroy tumors that cannot be removed from the body. Unlike standard cryotherapy probes, Dr. Fingers’ devices are spatulated (flat oval surfaces). Thus they offer larger and more uniform targeted zones compared to retinal cryotherapy tips often used in other centers. Simply put, using these probes decreases the chance of missing a small area of tumor. Dr. Finger has also used these large cryotherapy probes to grasp tumors of the orbit and facilitate enucleation surgery.
The Finger Iridectomy Technique
Dr. Finger was unhappy about the safety of needle biopsy. He didn’t like the fact that the biopsy needles were pointed and sharp along their edges (see image below).
He also didn’t like the fact that when placed in the tumor and assistant made manual poorly controlled suction. Biopsy needles caused too much bleeding, which clouded the biopsy view. Therefore, for tumors of the iris and ciliary body, and he invented the “Finger Iridectomy Technique.” This technique uses a relatively safe and rounded aspiration cutter through a self-sealing corneal incision to biopsy intraocular tumors. Unlike the needle, the aspiration cutter tip has no sharp edges:
The aspiration cutter is attached to a surgical machine that carefully regulate the suction. Unlike needle biopsy that only retrieves cells for cytology, the Finger Iridectomy Technique typically obtains both cells and small chunks of tumor. This allows Dr. Finger’s pathologists to evaluate cytology, histopathology, and perform immunohistochemical analysis. So far there has been no vision loss related to biopsy, and Dr. Finger has found that this technique almost always (>99%) will get enough tumor to make the diagnosis.
Finger’s Slotted Plaques for Choroidal Melanoma
Dr. Finger wanted to offer an eye and vision-sparing alternative to removal of the eye for patients with intraocular tumors touching, surrounding, or even covering the optic nerve. He knew the optic nerve exits the back of the eye, creating a 5-6 mm obstruction to placement of radiation to cover the whole tumor. So he invented “Finger’s Slotted Plaques.”
Dr. Finger designed these new radiation devices to work around incorporating the orbital portion of the optic nerve within the plaque. For the first time, the radiation treatment zone (for tumors near and around the optic nerve) was “normalized” and extended to cover the entire tumor. This innovation has improved local control, and saved vision and lives for patients with this previously hard-to-treat choroidal melanoma.
With Dr. Finger’s slotted plaque innovation and extra-large 24 mm diameter plaques, 93% of patients with choroidal melanoma who are treated at The New York Eye Cancer Center don’t have to have their eye removed (enucleation). This is important because most patients want to keep their eye.
Before and after treatment with Finger’s Slotted Plaques.