- 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 2: Mask preparation & retrobulbar block

Step 3: Imaging (MRI scan & planning CT scan) with retrobulbar block

Step 4: Image fusion, contouring & planning

Step 5: Treatment execution with retrobulbar block

Step 6:Post-treatment recovery from retrobulbar block and follow up evaluation

Visual acuityField of visionColor visionUSG, VEP, Visual field mapping

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

CK: 20 Gy in single fraction

Case 1: Choroidal melanomaCK planning

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

Re RT 26 month FU

Case 3: Low grade orbital adenexal lymphomaFollow up evaluation

Case 3: Low grade orbital adenexal lymphomaPost CK Fundoscopy

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.