Faculty Bibliography

OBJECTIVE: To describe clinical experience with palladium 103 ((103)Pd) ophthalmic plaque radiotherapy for choroidal hemangioma. METHODS: One course of (103)Pd ophthalmic plaque radiotherapy was used in each of 5 patients with circumscribed choroidal hemangioma who had progressive loss of vision due to subretinal exudation. A mean apex dose of 2900 cGy (2900 rad) was delivered. Functional tests of outcome included best-corrected visual acuity. Anatomic results included changes in tumor height and subretinal fluid documented by ophthalmoscopy, fluorescein angiography, and ultrasonography. RESULTS: All patients had complete resolution of subretinal fluid with reattachment of the retina. All tumors decreased in height (mean, 50%) after treatment. Three patients (60%) demonstrated improvement in visual acuity at the last follow-up, and in 1 patient vision remained stable with resolution of metamorphopsia. Twenty-four months after treatment, 1 patient whose visual acuity had recovered from 20/160 to 20/32 had a loss of vision to 20/160 because of radiation maculopathy. For all patients, a mean visual acuity improvement of 2 lines was documented (95% confidence interval, 0.23-0.88). Mean follow-up was 18.6 months (range, 6-29 months). CONCLUSIONS: A single (103)Pd plaque radiation treatment was effective in decreasing tumor height, eliminating subretinal fluid, and improving visual acuity in patients with symptomatic circumscribed choroidal hemangiomas

PURPOSE: To evaluate the use of leaded safety glasses to block radiation and allow for vision during ophthalmic plaque radiation therapy. DESIGN: Interventional case series. METHODS: Eight patients were treated with palladium 103 ophthalmic plaque radiotherapy and measured for emitted radiation while wearing leaded glasses or a lead patch. Radiation emission was measured at 1 m so as to compare the glasses' ability to block radiation in vivo. RESULTS: In two patients the tumor was in the patients' only seeing eye, and the leaded radiation safety glasses allowed them to function (feed themselves and walk to the bathroom unassisted). In two additional patients, the glasses allowed binocularity and were preferred over the patch. Measurements revealed that both the lead patch and leaded radiation safety glasses reduced exposure to levels acceptable for discharge to home in New York City. CONCLUSIONS: Leaded radiation safety glasses improved patients' quality of life without sacrificing radiation safety