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Eye-preserving radiation for melanoma inside the eye
Plaque Brachytherapy — An Eye-Preserving Option for Ocular Melanoma
A melanoma inside the eye does not always mean losing the eye. Plaque brachytherapy treats the tumour from the outside of the eyeball using a small radioactive disc, stitched on for a few days and then removed. NCCN lists it as a standard option for small and medium-sized tumours. It is not right for every eye, and nobody can promise what your sight will be afterwards.
Medically reviewed by Dr. Gangadhar Vajrala, Radiation Oncologist, MBBS · MD (Radiation Oncology) · MPH · Last reviewed August 2026
- The eye is not opened and not removed — The plaque is stitched to the outside of the eyeball, over the tumour. Nothing is inserted into the eye itself.
- It is a listed option, not an experiment — NCCN lists plaque brachytherapy as a standard option for small and medium-sized melanoma inside the eye, on the strength of the Collaborative Ocular Melanoma Study.
- Vision is planned for, out loud, before you consent — The plan weighs dose to the optic nerve, the central retina and the lens. What is realistic for your eye is said in advance — and never promised.
- Delivered at an NABH-accredited partner centre — CION Cancer Clinics coordinates your treatment plan, your oncology team and your care throughout. CION does not own or operate the equipment.
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The direct answer
Can the Eye Be Saved With Plaque Brachytherapy?
Often, yes. Plaque brachytherapy is designed to treat a melanoma inside the eye while leaving the eye in place. A small radioactive disc is stitched to the outside of the eyeball, directly over the tumour, left there for a few days, then removed in a second short operation. Keeping the eye is the intent.
Keeping the eye is the intent. It is not a promise, and you should be wary of anyone who makes it one. Whether your eye can be treated this way depends on the size and thickness of the tumour and on where it sits in relation to the optic nerve and the centre of vision.
What you can reasonably ask for is a straight answer about your eye, in writing, before you consent to anything. Call 1800 202 8726 and a radiation oncologist will read your reports first.
Keeping the eye and keeping the sight in it are two separate questions. Ask them separately, and ask both before treatment rather than after.
Here is the part many patients are never told. For melanoma inside the eye, removing the eye is not the only route. NCCN guidance lists plaque brachytherapy as a standard option for small and medium-sized choroidal melanoma, on the strength of the Collaborative Ocular Melanoma Study, and it sits alongside removal of the eye rather than beneath it. Yet a great many patients reach the decision having heard only one option described.
This page exists to give you the other conversation in advance: how the plaque is actually placed, how long it stays on, what those few days in hospital involve, what happens to vision afterwards, and what the years of follow-up commit you to. It is not an argument against removing the eye. Sometimes removal is the right call. It is what you need in order to ask for a proper comparison.
Where this happens matters, so it is worth being exact. Your radiotherapy is delivered at an NABH-accredited partner centre with an ocular oncology theatre and a radiation physics team; CION Cancer Clinics coordinates your treatment plan, your oncology team and your care throughout. CION does not own or operate the equipment, and CION is not itself NABH-accredited. Knowing exactly who does what, and where, is a fair thing to ask on the first call.
The procedure, step by step
How Is the Plaque Placed on the Eye?
The plaque is stitched to the outside of the eyeball, over the tumour. The eye itself is never opened and nothing is inserted into it. Under anaesthetic, the surgeon lifts the thin membrane covering the white of the eye, locates the tumour through the eye wall, marks the spot and sews the plaque onto it.
1
The tumour is measured before anything is ordered
An examination of the back of the eye, ultrasound of the eyeball to measure thickness and base diameter, fundus photographs, and sometimes further imaging. These measurements decide the size and shape of plaque, and they decide whether a plaque is suitable at all.
2
A physicist calculates how long it must stay on
The plan works out the dose the tumour needs, and what the optic nerve, the central retina and the lens will receive along the way. From that comes the number of days the plaque stays on. This calculation, not a standard protocol, is what sets your timetable.
3
In theatre, the tumour is found from the outside
Under general or local anaesthetic, the conjunctiva is lifted and the shadow of the tumour is located through the wall of the eye using transillumination or ultrasound. Its edges are marked on the sclera. If an eye muscle is in the way, it is temporarily released.
4
A dummy plaque confirms the position first
A non-radioactive plaque of the same size is usually placed and checked before the real one goes on. This is the step that stops the plaque sitting off-centre, which is the most avoidable reason a treatment ends up missing part of the tumour.
5
The plaque is sewn on and covered over
The radioactive plaque is stitched to the sclera over the marked area, any released muscle is stitched back, and the conjunctiva is closed over the top. A pad and a shield go over the eye. You wake up with the eye intact and the plaque out of sight.
6
A second short operation takes it off
Once the calculated time is up, you go back to theatre briefly. The conjunctiva is opened, the plaque is lifted off, muscles are reattached and the membrane is closed again. Nothing radioactive remains in the eye once the plaque leaves the room.
Sequence summarised from ASTRO and NCCN patient-facing guidance on ophthalmic plaque brachytherapy, current as of August 2026. Local practice varies, and your surgeon will describe their own version of these steps at consent.
Did you know?
NCCN lists plaque brachytherapy as a standard option for small and medium-sized melanoma inside the eye, on the strength of the Collaborative Ocular Melanoma Study — it is neither experimental nor a last resort. The most useful sentence you can carry into a consultation is the direct one: “Is my tumour suitable for a plaque, and if not, why not?”
The timeline
How Long Does the Plaque Stay On?
Usually between about three and seven days. The exact time comes from the physicist’s calculation for your tumour, not from a fixed rule. You stay in hospital for that period, in a room arranged for radiation safety, with a shield over the treated eye. The plaque delivers its dose continuously, so there is nothing for you to do.
| Stage | What happens | Usual timing |
|---|---|---|
| Measurement and planning | Eye examination, ultrasound of the eyeball, photographs, plaque selection and the dose calculation. | Days to a couple of weeks before admission. |
| First operation | The plaque is stitched onto the outside of the eye over the tumour. Usually a short procedure. | Day of admission. |
| The plaque stays on | Continuous treatment. You are awake, eating normally and mostly bored. The eye is padded and shielded. | About three to seven days, set by the calculation. |
| Radiation safety while it is on | A designated room, a shield over the eye, visits kept short and at a distance. Children and pregnant visitors are asked to wait. | Only for the days the plaque is in place. |
| Second operation | The plaque is removed, any released muscle is reattached, the membrane is closed. Nothing radioactive stays behind. | Same admission, on the calculated day. |
| Going home | A red, gritty, watery eye is expected for a week or two. Drops are prescribed. You carry no radiation. | Usually within a day of removal. |
| The tumour starts to shrink | Response is measured by ultrasound over months, not days. An unchanged measurement at six weeks is not a failure. | Months to years. |
Timings are typical, drawn from ASTRO and NCCN patient guidance current as of August 2026, and are offered so you can plan travel and leave. Your own dwell time comes from your plan and may sit outside this range.
Two things surprise people about those few days. The first is how uneventful they are. There is no machine, no daily trip to a treatment room and no sensation from the plaque itself. Most patients describe the discomfort as a stitch-like scratchiness rather than pain, and it is managed with simple measures your team prescribes.
The second is the visiting rules, which land hardest on families who have travelled a long way. While the plaque is on, you are a sealed radiation source, so visits are kept brief and at a distance, and children and pregnant relatives are usually asked to stay away until it is out. Tell your family this before they arrive, not at the ward door.
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MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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CION’s radiation oncology team can tell you whether a plaque is realistic for your tumour — and exactly what the treatment, the stay and the follow-up would involve.
The comparison
Plaque Brachytherapy, Removing the Eye, or Beam Radiation?
Three routes are usually on the table for melanoma inside the eye. A plaque keeps the eye and treats from the outside of the eyeball. Enucleation removes the eye and the tumour with it. Beam-based radiation, including proton therapy and stereotactic treatment, aims from outside the body. Tumour size and position decide which are realistic.
| Question | Plaque brachytherapy | Removing the eye (enucleation) | Beam radiation (proton / stereotactic) |
|---|---|---|---|
| Is the eye kept? | Yes, that is the purpose. | No. The eye is removed and an implant with a matched shell takes its place. | Yes, in most patients. |
| How is treatment given? | A radioactive disc stitched to the outside of the eyeball, over the tumour. | A single operation under general anaesthetic. | A beam aimed from outside the body, usually over several sessions. |
| How long does it take? | Two short operations with about three to seven days between them. | One operation, then healing and fitting of the shell over weeks. | A planning visit, then a short course of daily sessions. |
| Usually considered for | Small and medium-sized tumours in a position a plaque can cover. | Large tumours, a painful blind eye, or a tumour a plaque cannot cover. | Tumours close to the optic nerve, or where a plaque cannot sit well. |
| What happens to vision | Variable. Depends on how close the plaque sits to the optic nerve and the central retina. | No sight in that eye. The other eye takes over, and depth perception adjusts over months. | Variable, for the same reasons as a plaque. |
| Follow-up commitment | Eye examinations and ultrasound for years, plus scheduled body imaging. | Socket checks, plus the same scheduled body imaging. | Eye examinations for years, plus the same scheduled body imaging. |
| Availability in India | Limited to centres with an ocular oncology theatre and a physics team. | Widely available. | Proton facilities are few and are in a small number of cities. |
Comparison summarised from NCCN and ASTRO patient-facing guidance on uveal melanoma, current as of August 2026. It is a discussion aid, not a recommendation, and it does not replace the assessment of an ocular oncology team who have seen your eye.
Notice what the table does not contain: a winner. There is no single right answer here, and a clinician who gives you one without measuring the tumour has skipped the part that matters. Thickness, base diameter and the distance from the optic disc and the fovea are what move a patient from one column to another.
If removal has already been recommended to you, the useful question is not whether it is wrong. It is narrower and harder to deflect: “What measurement rules a plaque out in my case?” A good team will answer it in one sentence, with a number from your ultrasound report.
The honest part
What Happens to Your Vision Afterwards?
Keeping the eye and keeping the sight in it are different things. Many patients keep useful vision in the treated eye. Others lose a good deal of it over the years that follow. What decides it is mainly how close the tumour, and so the plaque, sits to the optic nerve and to the central retina.
Clouding of the lens
Radiation reaching the lens can cloud it over months to years. It is one of the more treatable late effects, and a routine day procedure usually restores what the retina behind it can still deliver.
Swelling or bleeding in the retina
Small vessels in the treated area can leak or close off, blurring central vision. It typically appears between one and three years. Picked up early at a scheduled check, there are treatments that can slow it.
Damage to the optic nerve
The risk rises the closer the tumour sits to the optic disc. This is the effect that most often costs central vision, and it is the main reason a plaque is sometimes ruled out in favour of a beam technique.
A dry, gritty or watering eye
Common in the weeks after surgery and sometimes for longer, because the surface and the tear film both take a hit. Under-treated far more often than it is untreatable.
Double vision
If an eye muscle was released to reach the tumour, alignment can be briefly off after the plaque comes out. It usually settles. Say so if it does not, because it can be corrected.
Pressure rising inside the eye
Less common, and a reason some eyes are removed later despite a treated tumour. It is one of the specific things every follow-up examination is checking for.
Late effects and their usual timing are drawn from ASTRO and NCCN patient guidance on ocular radiation, current as of August 2026. Ranges are typical, not predictions for your eye.
Two of these have pages of their own, because they are the ones patients most often meet without warning. Cataract after radiation sets out when clouding of the lens tends to appear and what can be done about it, and dry eye, watering and eyelid changes after orbital radiation covers the surface problems that make an eye feel worse than it looks.
The sentence worth taking into your consent appointment is this one: ask what your team expects for your eye specifically, and ask what is realistic rather than what is possible. A team that answers plainly, including the parts you did not want to hear, is the one to trust with the follow-up.
Afterwards, and from a distance
What Follow-Up Is Needed, and Can This Be Arranged From Another City?
Follow-up runs for years and has two halves: the eye, and the rest of the body. The eye is examined and measured by ultrasound at set intervals. Scheduled imaging watches elsewhere, the liver in particular, because melanoma from inside the eye can travel there. Both halves can be coordinated from another city or country.
1
The eye is measured, not just looked at
Ultrasound at each visit tracks tumour thickness. Shrinkage is slow, so an unchanged measurement early on is not a failure. Your team will tell you what they expect to see and by when.
2
Late effects are looked for on purpose
Pressure inside the eye, the state of the lens, the retina and the optic nerve are each checked deliberately at every visit, because most of them are treatable when they are caught early and not when they are not.
3
Scheduled body imaging continues
Melanoma from inside the eye can appear elsewhere years later, most often in the liver. Imaging and liver blood tests continue on a schedule your team sets, regardless of how well the eye is doing.
4
An agreed trigger for coming back early
Settle in advance what brings you in before the scheduled date: a sudden drop in vision, a red painful eye, new flashes or a curtain across the field of view. Write it down; do not keep it in your head.
5
Send the reports before you book the flight
Eye ultrasound report, fundus photographs, any scans and the referring note can go ahead by email or WhatsApp. A written opinion and an indicative cost estimate, as of August 2026, come back before anyone travels.
6
One coordinator, not a switchboard
Families arranging this from abroad or from another state get a single point of contact who sequences the two procedures, the stay between them and the follow-up plan. Time zones are worked around, not ignored.
Be realistic about the travel window. Two procedures with several days between them means planning for a stay of roughly a week to ten days, plus the earlier planning visit and a review afterwards. Ask for those dates in writing before booking anything, and ask who to call if a date moves.
If you are also taking something from Ayurveda, homeopathy or another tradition, there is no need to stop it quietly or to expect judgement for saying so. Just tell your oncology team what it is, so nothing interacts unnoticed and the picture they are working from is the complete one.
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Common questions
Plaque Brachytherapy for Ocular Melanoma — Your Questions Answered
How is the plaque placed on the eye?
The plaque is stitched to the outside of the eyeball, over the tumour. The eye itself is never opened. Under anaesthetic, the surgeon lifts the thin membrane covering the white of the eye, finds the shadow of the tumour through the eye wall using transillumination or ultrasound, and marks the spot. A dummy plaque is often placed first to confirm the position. The radioactive plaque is then sewn onto the same spot and the membrane is closed over it. One or two of the muscles that move the eye are sometimes released to reach the site, and they are reattached before you wake up. A second short operation removes the plaque once the planned dose has been delivered.
How long does the plaque stay in place?
Usually somewhere between about three and seven days. The exact time comes from a calculation, not from a fixed rule: the physicist works out how long that plaque, on that tumour, needs to sit there to deliver the planned dose. Tumour thickness, the strength of the source and the plaque size all change the answer. You normally stay in hospital for the whole period, in a room arranged for radiation safety, with a shield over the treated eye. The plaque works continuously while it is there, so there is nothing for you to do. A short second procedure under anaesthetic removes it, and once it is out nothing radioactive stays behind.
Can the eye be saved with plaque brachytherapy?
In many patients, yes. Keeping the eye is the whole point of the procedure, and NCCN guidance lists plaque brachytherapy as a standard option for small and medium-sized melanoma inside the eye, on the strength of the Collaborative Ocular Melanoma Study. It is not promised in advance, and no honest team will promise it. Whether the eye can be kept depends on how large and how thick the tumour is, where it sits in relation to the optic nerve and the centre of vision, and whether the eye is already painful or has high pressure inside it. A small number of eyes are removed later because the tumour does not settle, or because the eye becomes painful. That possibility is discussed before you consent, not afterwards.
Will my vision be the same after plaque brachytherapy?
Keeping the eye and keeping the sight in it are two different things, and it is fair to ask about them separately. Many patients keep useful vision in the treated eye. Others lose a great deal of it over the years that follow. What decides it is mostly geography: how close the tumour, and therefore the plaque, sits to the optic nerve and to the central part of the retina. Cataract, swelling or bleeding inside the retina, and damage to the optic nerve can all appear months to years later, and some of them are treatable if they are picked up early. Ask your team, before you consent, what they expect for your eye specifically. Ask what is realistic, not what is possible.
Am I radioactive while the plaque is in place, and is my family at risk?
While the plaque is on the eye it is a sealed radiation source, so simple precautions apply for those few days. You stay in a designated room, a shield covers the treated eye, and visitors are asked to keep their distance and their visits short. Children and anyone who is pregnant are usually asked not to visit until the plaque is out. Nothing is radioactive in your blood, your urine or your breath, and you cannot pass anything on by talking or by touching. The moment the plaque is removed, the source leaves with it. You go home carrying no radiation at all, and with no restrictions on holding your children or grandchildren.
Where is plaque brachytherapy done, and can it be arranged from another city or from abroad?
Plaque brachytherapy is carried out at an NABH-accredited partner centre with an ocular oncology theatre and a radiation physics team. CION Cancer Clinics does not own or operate that equipment. What CION does is coordinate: reading your eye ultrasound, fundus photographs and scans, arranging the opinion, sequencing the two procedures and the stay between them, and holding the follow-up plan afterwards. Families arranging this from another city or from outside India can send reports ahead by email or WhatsApp and receive a written opinion and an indicative cost estimate, as of August 2026, before anyone books a flight. One coordinator stays with the case from the first call to the last scan.