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

Abstract

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