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- Choroidal melanoma - Choroidal Haemangioma - Intra-ocular lymphoma - Choroidal metastasis
• Treatment of eye tumours with high precision radiation therapy such as
CyberKnife is possible with excellent reasonable long-term follow-up.
• Choroidal haemagioma, Choroid melanoma and orbital low grade
lymphomas are safely and effectively treatable with fractionated
radiosurgery.
• CyberKnife is feasible organ and function preserving option for
ophthalmological conditions.
• Early outcomes in selected indications are encouraging.
Robotic radiosurgery (CyberKnife) treatment in Eye tumours
- Choroidal melanoma - Choroidal Haemangioma - Intra-ocular lymphoma - Choroidal metastasis
Step 1: Assessment for suitability
Choroidal melanomaChoroidal haemangiomaOrbital lymphomaOptic nerve sheath meningioma
Step 6:Post-treatment recovery from retrobulbar block and follow up evaluation
Visual acuityField of visionColor visionUSG, VEP, Visual field mapping
Case 1: Choroidal melanomaCase history
32 yr Female from BangladeshC/O: progressive dimness of vision of right eye.320 slice CT scan: 2 mm nodule at the retina (fovea) CK plan: 20Gy/1#; prescription at 70% isodoseFollow up: At 32 months, stable disease. No deterioration of visual acuity
Case 2: Choroidal haemangioma: Case History
7 yr old male child from Kerala with Sturge Weber Syndrome had glaucoma and vision loss of right eye (only PL/PR) and progressive dimness of vision of left eye (6/36) 320 slice CT scan & MRI scan: Haemangioma left eye with retinal detachmentCK plan: 7Gy/1#; prescription at 85% isodoseFollow up: At 27 months, complete resolution of haemangioma and resorption of retinal detachment. At 2 months post CK, visual acuity improved to 6/18 and maintained till last follow up (27 month).
Case 2: Choroidal haemangiomaCK planning
Case 2: Choroidal haemangiomaFollow up evaluation
Case 3: Low grade orbital adenexal lymphomaCase History
56 yr old doctor from Kolkata with progressive loss of vision of both eyes. Right eye only PL/PR and left eye 6/36 visionMRI scan and PET scan: Retro-orbital mass left eye suggestive of lymphomaBiopsy: Marginal zone lymphoma (Low grade) CK plan: 21Gy/3#/3 days; prescription at 80% isodose to left eye and 35Gy/14#, 3DCRT to right eye. Follow up: At 26 months, PET scan showing complete resolution of mass and resorption of retinal detachment. Visual acuity of left eye at last follow up was 6/6 and right eye 6/18. There was no appreciable enopthalmos and no dryness of eye.
Case 3: Low grade orbital adenexal lymphoma CK planning
Re RT 26 month FU
Case 3: Low grade orbital adenexal lymphomaFollow up evaluation
Re RT 26 month FU
Case 3: Low grade orbital adenexal lymphomaFollow up evaluation
Summary
1. Treatment of eye tumours with high precision radiation therapy such
as CyberKnife is possible with excellent reasonable long-term follow-
up.
2. Choroidal haemagioma, Choroid melanoma and orbital low grade
lymphomas are safely and effectively treatable with fractionated
radiosurgery.
3. CyberKnife is feasible organ and function preserving option for
ophthalmological conditions.
4. Early outcomes in selected indications are encouraging.
