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The authors review the research results concerning the diagnosis and treatment of ocular tumors over 25 years of activities of Department of Ophthalmooncology and Radiology and analyze the perspective trends for future studies.

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The efficacy of enucleation and brachitherapy is assessed in 1150 patients. The incidence of metastases is the highest (up to 2/3) occurs within the first 3 years. Neither enucleation, nor brachitherapy affect this value. However, in general after enucleation the incidence of metastases to the liver (31.7%) is higher than after brachitherapy (5.8%), this indicating that brachitherapy is more effective in minor and medium-sized melanomas of the choroid.

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The authors assess the efficacy of brachytherapy of uveal melanomas in 954 patients. Strontium ophthalmoapplicators were used in 652, rutenium ones in 302 patients. As a rule, Sr applicators were sutured in patients with tumors up to 3.5 mm thick and Ru ones in cases with tumors thicker than 3.5 mm. A special program was used for individual approach and improving the accuracy of planning. A total of 74.5% of patients have been followed up for at least 3 years, with check-ups every 3-6 months. The effect of brachytherapy was considered positive in cases with complete resorption or at least 50% decrease of the tumor and a stable clinical picture for 9-12 months. In 60% of patients the tumor regressed completely, in 16% partially, and in 24% there were signs of activation of melanoma growth one year after treatment. The frequency of radiation complications was as follows: retinopaty, 3.15%; neuroretinopathy, 1.1%; hemophthalmia, 0.9%; neovascular glaucoma, 1.1%; cataract, 0.63%. The incidence of radiation complications increases with increase of the applicator power and rigidity of exposure. Computer planning of brachytherapy with due consideration for the size of the tumor and the eye and localization of the neoplasm for each case will help decrease the incidence of complications.

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Forty-two patients with juxtacapillary melanomas of the choroid were treated by brachytherapy. The treatment was carried out in two stages: Stage I--separating laser coagulation, Stage II--irradiation with ophthalmologic applicators (90Sr, 90I). Complete resorption was achieved in 12 patients, partial regression with the process stabilization in 17, no effect in 13, in 11 of these enucleation had to be performed. The mean follow-up period has made up 6.8 years. Analysis of brachytherapy results has lead the authors to a conclusion that this treatment modality may be considered as enucleation alternative in patients with juxtacapillary melanomas located by the optic disk and covering not more than 1/3 of its perimeter, with the prominence of less than 3 mm; brachytherapy applicator in this case should be US monitored.

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The authors have examined the possibility of preventing the development of secondary glaucoma after eye irradiation with a narrow medicinal proton beam. Twenty-eight patients with cilio-choroidal melanoma were involved in the study, 7 male and 21 female ones, aged 48.4 on an average. The authors' findings evidence that postradiation changes in the anterior segment of the eye, resulting from radiation iridocyclitis, are mainly responsible for the development of secondary glaucoma. Preliminary laser-effected formation of iridal coloboma is conducive to a normal flow in the anterior chamber at the expense of an additional pupil functioning and thus helps reduce the possibility of secondary glaucoma development by 1.6 times (or by 38.5%).

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This paper presents the effects of proton beam therapy of 175 patients with tumors of the eye. Irradiation was performed with a narrow medical proton beam (Institute of Theoretical and Experimental Physics) with the energy of 70 MeV (Bragg's peak). The total dose was 6000-7000 rad, irradiation frequency was 5-6 sessions every other day. Irradiation was used to treat intraocular and orbital melanomas, melanomas an cancer lesions of the eyelid and conjunctiva. According to the WHO classification, tumors fell under the T2-T3N0M0 stage. The follow-up periods varied from 1 to 10 years (an average of 3.4 years). Complete tumor regression was observed in 45% of the cases, partial regression in 39%, and the absence of the effect in 16%. Twenty-two patients (12%) underwent enucleation due to progressive tumor growth (16 patients) or postradiation complications (6 patients). Hematogenous metastases within a period of 2-5 years following irradiation were noted in 4% of the cases. The results obtained indicated a high efficacy of proton beam therapy for large ocular tumors. The mortality rate from metastases following irradiation was lower than that following enucleation.

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We treated 63 patients with intraocular melanomas by means of a narrow medical proton beam. Tumors were irradiated with 2,500 rad at each of four to five sessions, with an interval of one to two days between sessions. The melanomas ranged in diameter from 8 to 20 mm and were from 3.0 to 13.7 mm in thickness. Patients were followed up for three months to seven years. In 11 cases, the tumor was fully resorbed. Complications included radiation cataract, postradiation glaucoma, radiation retinopathy, and exudative retinal detachment. In 12 cases, enucleation was performed because tumor growth persisted. Four patients died during follow-up period because of metastasis. The eye was preserved in 47 cases.

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