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

1. - Choroidal melanoma
- Choroidal Haemangioma
- Intra-ocular lymphoma
- Choroidal metastasis

2. • 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

3. Step 1: Assessment for suitability
Choroidal melanoma
Choroidal haemangioma
Orbital lymphoma
Optic nerve sheath meningioma

4. Step 2: Mask preparation & retrobulbar block

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

6. Step 4: Image fusion, contouring & planning

7. Step 5: Treatment execution with retrobulbar block

8. Step 6:Post-treatment recovery from retrobulbar block
and follow up evaluation
Visual acuity
Field of vision
Color vision
USG, VEP, Visual field mapping

9. Visual field mapping

10. Case 1: Choroidal melanoma
Case history
32 yr Female from Bangladesh
C/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%
isodose
Follow up: At 32 months, stable disease. No
deterioration of visual acuity

11. CK: 20 Gy in single fraction
Case 1: Choroidal melanoma
CK planning

12. 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 detachment
CK plan: 7Gy/1#; prescription at 85% isodose
Follow 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).

13. Case 2: Choroidal haemangioma
CK planning

14. Case 2: Choroidal haemangioma
Follow up evaluation

15. Case 3: Low grade orbital adenexal lymphoma
Case 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 vision
MRI scan and PET scan: Retro-orbital mass left eye
suggestive of lymphoma
Biopsy: 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.

16. Case 3: Low grade orbital adenexal lymphoma
CK planning

17. Re RT 26 month FU
Case 3: Low grade orbital adenexal lymphoma
Follow up evaluation

18. Re RT 26 month FU
Case 3: Low grade orbital adenexal lymphoma
Follow up evaluation

19. Re RT 26 month FU
Case 3: Low grade orbital adenexal lymphoma
Follow up evaluation

20. Case 3: Low grade orbital adenexal lymphoma
Post CK Fundoscopy

21. 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.