Stereotactic radiosurgery (SRS) and fractionated stereotactic radiiotherapy (fSRT) have emerged as promising, non invasive treatments for uveal melanoma. Although, historically melanoma has been considered a relatively radioresistant tumor, newer data have challenged this viewpoint, and radiation therapy is now considered to be a useful component of the therapeutic armamentarium for malignant melanoma. But still there is a need for multicenter trials to compare the outcomes following stereotactic radiosurgery (SRS) in the treatment of uveal melanoma.

1. DR.NIMESH DAHIMA
Consultant Oncologist
Shalby Hospital, Indore

2.  A 63 year old male.
 Decreasing vision since 3 months in Left Eye.
 f/b Complete loss of vision in Left Eye
 Severe Pain in Left Eye since 5 days
 Red discoloration of Conjunctiva in Left Eye
since 5 days.

3.  Right Eye Vision Normal
 No c/o Vertigo or vomiting
 Quit Gutkha chewing and smoking 6 years
back.
 Co morbidities:- Hypertensive (on treatment
since 2 years)

4. ON EXAMINATION LEFT EYE:
 Prominent Conjuctival Vessels
 Haemorrhage Present
 Lens Opacified
 Pupil Not reacting
 Lids OK
 Right Eye; Lens matured, Conjuctiva (N), Pupil
Reacting, Lids (N)
 No Neck Lymphadenopathy

5.  CT Scan (Dec2016) : e/o an enhancing
lobulated intraocular mass lesion seen
Posteriorly on left side eye.
◦ Polypoidal contrast enhanced lesion (13 x 10 x 12
mm)
◦ Choroidal Haemorrhage present- Max wall
thickness 6 mm.
◦ Abutting optic disc Posteriorly
◦ Optic Nerve -Normal
◦ No e/o Intra & Extra Coanal infiltration.
◦ Right Eye - Normal

6.  Screening MRI: Shows the lesionto be
hyperintense on T1w and Hypointense on T2
w.
 Chest X ray PA view 5/12/16 Normal Study
 EYE Scan:- A Bilobed mass noted in the nasal
quadrant abutting optic nerve reaching up till
posterior pole with medium surface reflection
and medium internal reflection associated
choroidal excavation. Total Retinal
Detachment +nt.

27.  USG LEFT EYE (08/05/17):- A well defined
round lesion of size approx 9.7 x 9.7 mm
along the posterior wall of the orbit with
almost no internal vascularity (size is almost
same as compared to previous study).
 The retinal detachment is also seen (however appears
decreased compared to previous scan).

30.  USG LEFT EYE (23/11/17):- A well defined
round lesion of size approx 9.3 x 6.6 mm
along the posterior wall of the orbit with
almost no internal vascularity (size decreased
compared to previous study).
 The retinal detachment is also seen (however appears
decreased compared to previous scan).

32.  USG Left Eye (30/10/18):- A well defined
round lesion of size approximately 5.6 x 4.6
mm along the posterior wall of the orbit with
almost no internal vascularity .
 Also there is adjacent presence of retinal
detachment.
 Anterior chamber appears collapsed.
 AP diameter of eye is decreased (16.2 mm)

40. AVM
DOSE 18GY/1#

41. DOSE 30GY/5#
MENINGIOMA 85 YR OLD MALE

42. CEREBELLAR GLIOMA 75 YR OLD FEMALE
PRE SRS POST SRS 3 MONTHS
DOSE 30 GY/5#

44. ACOUSTIC NEUROMA 33 YR OLD FEMALE
PRE SRS POST SRS 6 MONTHS
DOSE 13 GY