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. 2025 Feb;39(3):533-537.
doi: 10.1038/s41433-024-03562-8. Epub 2025 Jan 14.

Ultrasound guided Ru106 plaque brachytherapy for treatment of exudative retinal detachment in children with diffuse choroidal haemangioma

Anusha Venkataraman  1   2 , Ali Al-Gilgawi  1 , Ian Stoker  3 , M Ashwin Reddy  1 , Mandeep S Sagoo  4   5   6
Affiliations

Ultrasound guided Ru106 plaque brachytherapy for treatment of exudative retinal detachment in children with diffuse choroidal haemangioma

Anusha Venkataraman et al. Eye (Lond). 2025 Feb.

Abstract

Purpose: To evaluate the efficacy of ultrasound-guided ruthenium (Ru 106) plaque brachytherapy for treatment of exudative retinal detachment in diffuse choroidal haemangioma (DCH).

Methods: Retrospective analysis of four paediatric patients treated with ultrasound-guided Ru 106 plaque brachytherapy for DCH with total exudative retinal detachment directed to the thickest part of the DCH. A dose of 40 Gy to the tumour apex was delivered in all patients. The outcomes of treatment were regression of DCH, resolution of retinal detachment, development of neovascular glaucoma or any other radiation-associated complications which were assessed clinically and with B scan ultrasonography.

Results: There were 4 eyes included in the study, with a mean (median, range) age of 8.75 (8.4, 3-15) years. The pre-operative tumour thickness was 5.0 (5.12, 4.2-5.5) mm. The visual acuity ranged from 0.8-2.8 LogMAR and 3 of 4 eyes had only light perception at presentation. One eye had been treated with goniotomy for pre-existing secondary glaucoma and was on topical antihypertensive medications. At a mean follow-up of 14.6 months (10.5 months, 6-30 months), all patients showed regression of the tumour. The mean tumour thickness reduced to 2.05 mm (2.44 mm, 1.1-2.6 mm) post-operatively. All patients (4/4) had complete resolution of the retinal detachment. The visual acuity remained stable in all the patients with none of the patients developing neovascular glaucoma or any other radiation-related complications.

Conclusion: Ultrasound-guided Ru 106 plaque brachytherapy is an effective treatment strategy as a primary treatment in the absence of external beam radiotherapy, to achieve tumour regression and resolution of retinal detachment in DCH.

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Conflict of interest statement

Competing interests: None of the other authors have any financial disclosures or conflicts of interest to declare. This manuscript has not previously been submitted for publication. The research was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. This paper presents a novel method of imaging with brachytherapy, in an area of ophthalmology that is both rare and important. The material here is original research, not previously published.

Figures

Fig. 1
Fig. 1. Ultrasound-guided Ru106 plaque brachytherapy for treatment of exudative retinal detachment in children with diffuse choroidal haemangioma.
Images of intra-operative B scan ultrasound confirming position of dummy plaque (a: solid arrow) and the active plaque (b: interrupted arrow) adjacent to the thickest area of the tumour. (Case 3).
Fig. 2
Fig. 2. Ultrasound guided Ru 106 plaque brachytherapy for treatment of exudative retinal detachment in children with diffuse choroidal haemangioma.
Pre-operative (a) and post-operative (b) B scan ultrasound images of an eye with diffuse choroidal haemangioma that underwent ultrasound-guided plaque brachytherapy showing tumour regression and resolution of exudative detachment after 7 months. (Case 1).
Fig. 3
Fig. 3. Colour fundus (Retcam) images of an eye before and after ultrasound-guided Ru 106 plaque brachytherapy for diffuse choroidal haemangioma. (Case 3).
a Pre-operative colour fundus (Retcam) image of an eye with total retinal detachment that underwent ultrasound-guided plaque brachytherapy. b Post-operative colour fundus photograph image of the same eye after plaque brachytherapy showing complete tumour regression and resolution of exudative retinal detachment after 6 months.
See this image and copyright information in PMC

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