Photo Credit: Jitendra

The following is a summary of “Adjuvant Brachytherapy Using Iodine-125 Plaques for Conjunctival Melanoma with Scleral Invasion,” published in the March 2025 issue of Seminars in Ophthalmology by Bonnell et al. 

Researchers conducted a retrospective study to define outcomes in individuals with unresectable conjunctival melanoma treated with surgical excision followed by adjuvant iodine-125 plaque brachytherapy.  

They reviewed a consecutive series of individuals diagnosed with scleral-invasive conjunctival melanoma at a single institution and treated with adjuvant plaque brachytherapy. Pre-operative, radiation, and post-operative data were collected for everyone. Evaluations included intraocular pressure, visual acuity (VA), radiation-related complications, local recurrence, and the presence of metastatic disease.  

The results showed that 9 individuals met the inclusion criteria. All underwent surgical excision followed by iodine-125 plaque brachytherapy at a dose of 85 Gy to a depth of 3 mm from the plaque face for 2–3 days. The median follow-up period was 45 months (range: 3–66). No local recurrences were observed. After surgery, 4 out of 9 individuals (44%) retained VA of 20/50 or better. Mean VA declined from Snellen 20/59 preoperatively to 20/209 postoperatively. Limbal stem cell deficiency occurred in 3 individuals (33%), potentially linked to additional treatments, including mitomycin C eyedrops (n=2) and proton beam radiation (n=1) and 1 individual with a high-risk forniceal conjunctival melanoma developed metastatic disease.  

Investigators concluded that iodine-125 plaque brachytherapy, delivering 85 Gy over 3 days, was safe and effective for vision and tumor control in scleral-invasive conjunctival melanoma. 

Source: tandfonline.com/doi/full/10.1080/08820538.2025.2479781