eight were with posterior choroidal melanomas , one with ciliary body melanoma , three with retinoblastomas and one with vpt . all the cases with melanomas underwent chest x - ray , ultrasound of abdomen and clinical examination by an oncologist to rule out metastasis . we used the plaque simulator software version 5.3.9 ( bebig gmbh , berlin , germany ) , developed by one of the authors ( ma ) . modelling of the eye is done first using axial computerized tomography or magnetic resonance image , from the center of the eye . the fundus image is next uploaded on the software to chart the tumor location and also to measure the exact distance from optic disc to fovea . the prescription point is the apex of the tumor for all having apical diameter > 5 mm and it is kept at 5 mm for all tumors with apical diameter < 5 mm . the average dose rate in our study was 0.62 gy / hr ( range 0.44 - 0.9 gy / hr ) , given over 2 - 8 days depending on the tumor type and size . ( a ) longitudinal section of computerized model of the eye ball with the tumor ( posterior melanoma ) as seen in the planning software . the various doses of radiation the tumor is exposed to once the plaque is fixed on the sclera and is demonstrated in different colors . note 85 gy ( black color ) is just covering the apex of the tumor . ( b ) computerized model of transverse section of the same tumor on retinal chart commercially both rimmed and unrimmed plaques are available . the coms plaques are circular rimmed plaques available in five sizes , 12 , 14 , 16 , 18 and 20 mm . second , as they are circular in shape , they can not be used for tumors near the optic nerve which would require a notched plaque . third , the seeds have to be loaded on a siliastic carrier which is then fitted over the plaque [ fig . 2 ] . thus when placed over the eye , there is a 1-mm gap between the seeds and the sclera . hence higher dose is required to reach the tumor apex which correspondingly increases the scleral dose and also to the structures distal to the apex . fifth , as there is lateral overlap of the radiation from the corresponding seeds , the effective dose to sclera is higher . all these disadvantages are partly overcome by the unrimmed slotted plaques ( eyephysics , llc , los alamitos , ca ) . three of the currently available plaques , models 517 , 917 and 2025 are pictured in fig . being unrimmed , they are thin ( 2 mm ) and can easily be passed behind the rectii muscles without resecting them . the model 917 also has a notch which can accommodate the optic nerve for tumors close to it . because the i seeds are glued into individually collimating slots carved into the concave surface of the gold plaque , the seeds are closer to the sclera compared to the seeds in the siliastic carrier of a coms plaque . most of the laterally directed soft radiation emanating from the seeds in an eye physics plaque is blocked by the gold collimation , eliminating much of the radiation overlap immediately in front of the plaque [ fig . 4 ] . ( a ) circular coms plaque seen above along with the corresponding circular siliastic carrier below which is loaded with the i-125 seeds . ( b ) siliastic carrier fitted in the coms plaque with the seeds on inside surface ( a - c ) models 517 , 917 and 2025 slotted gold plaques ( eyephysics , llc , los alamitos , california , usa ) along with the corresponding dummy plaques ( wire frames ) . note model 917 in the center has a notch for tumors close to optic nerve ( a ) illustration of coms plaque showing a gap between the seeds and the sclera . hence higher dose is required to reach the tumor apex which correspondingly increases the scleral dose and also to the structures distal to the apex . there is lateral overlap of the radiation from the corresponding seeds ( dark yellow ) . ( b ) slotted plaque showing the seeds closer to sclera and minimal overlap of radiation ( dark yellow ) compared to coms plaque , hence lesser dose to sclera reducing this overlap more than compensates for the anticipated  inverse - square  increase in dose to the sclera adjacent to each seed that results from the seeds being closer to the sclera ( compared to the coms plaque ) . it also reduces radiation to the structures adjacent to the plaque edges and distal to the tumor apex . barc i ocu - prosta seeds consisting of i source of dimension 4.75 mm ( l )  0.8 mm (  ) encapsulated in titanium capsules were supplied by radiopharmaceuticals division of bhabha atomic research center , mumbai . a novel method of adsorption of radioiodine ( i ) on palladium - coated silver rod was developed . by this method , 3 - 4 mci of i these sources were encapsulated using a 50-w , neodymium : yttrium - aluminum - garnet laser welding system . the laser - welded sources were subjected to numerous checks such as visual inspection , activity measurement , swipe test , leak test , immersion test , etc . ( b ) barc i-125 ocu - prosta seeds once the basic dosimetry is done , seeds were placed into the slots of the plaque and glued to achieve a desired dose rate distribution . the typical activity used were 3 - 4 mci per seed so as to achieve treatment dose rates of 0.5 - 1.25 gy / h , with a prescription dose of 40 - 80 gy delivered in 5 - 12 consecutive days . prior to surgery , the plaque was sterilized by flash autoclaving for 4 minutes . under peribulbar block localized peritomy the tumor margins were identified using transscleral illumination and indirect ophthalmoscopy . a minimum safety margin of 2 mm is maintained . then the exact distance of suture placement points from the limbus are marked with marker pen using a calliper . the dummy plaque (  cold plaque  ) is then secured with temporary knots after passing the sutures through the eye - lets . the placement of the dummy plaque is confirmed by indirect ophthalmoscopy and scleral indentation . keeping the episcleral sutures in place , the dummy plaque is then replaced with the  hot plaque  containing the radioactive seeds and then the suture knots are made permanent [ fig . 6 ] . the plaque is then removed after an appropriate time as per the dosimetry . during that time the patient is kept in an isolated room with the eye covered with a lead shield . immediately after the plaque removal , the eye this is to make sure that all the seeds have been removed and none are left behind accidently . the seeds are then unloaded by the physicist after soaking it for few minutes in acetone and sent back in a special lead container for proper disposal . ( b ) localisation of the dummy plaque being confirmed with indirect ophthalmoscopy and scleral indentation ( not shown ) . ( c )  hot plaque  with the radioactive i-125 seeds loaded shown just before insertion ( after removing the cold plaque ) . ( d ) the hot plaque being inserted with the seeds facing the sclera all steps of the treatment procedure were planned in advance to minimize radiation exposure of personnel . the personnel involved in this work were monitored for radiation exposure levels by thermoluminescent dosimetry ( tld ) badge . we used the plaque simulator software version 5.3.9 ( bebig gmbh , berlin , germany ) , developed by one of the authors ( ma ) . modelling of the eye is done first using axial computerized tomography or magnetic resonance image , from the center of the eye . the fundus image is next uploaded on the software to chart the tumor location and also to measure the exact distance from optic disc to fovea . the prescription point is the apex of the tumor for all having apical diameter > 5 mm and it is kept at 5 mm for all tumors with apical diameter < 5 mm . the average dose rate in our study was 0.62 gy / hr ( range 0.44 - 0.9 gy / hr ) , given over 2 - 8 days depending on the tumor type and size . ( a ) longitudinal section of computerized model of the eye ball with the tumor ( posterior melanoma ) as seen in the planning software . the various doses of radiation the tumor is exposed to once the plaque is fixed on the sclera and is demonstrated in different colors . note 85 gy ( black color ) is just covering the apex of the tumor . the coms plaques are circular rimmed plaques available in five sizes , 12 , 14 , 16 , 18 and 20 mm . second , as they are circular in shape , they can not be used for tumors near the optic nerve which would require a notched plaque . third , the seeds have to be loaded on a siliastic carrier which is then fitted over the plaque [ fig . 2 ] . thus when placed over the eye , there is a 1-mm gap between the seeds and the sclera . hence higher dose is required to reach the tumor apex which correspondingly increases the scleral dose and also to the structures distal to the apex . fifth , as there is lateral overlap of the radiation from the corresponding seeds , the effective dose to sclera is higher . are partly overcome by the unrimmed slotted plaques ( eyephysics , llc , los alamitos , ca ) . three of the currently available plaques , models 517 , 917 and 2025 are pictured in fig . being unrimmed , they are thin ( 2 mm ) and can easily be passed behind the rectii muscles without resecting them . the model 917 also has a notch which can accommodate the optic nerve for tumors close to it . because the i seeds are glued into individually collimating slots carved into the concave surface of the gold plaque , the seeds are closer to the sclera compared to the seeds in the siliastic carrier of a coms plaque . most of the laterally directed soft radiation emanating from the seeds in an eye physics plaque is blocked by the gold collimation , eliminating much of the radiation overlap immediately in front of the plaque [ fig . 4 ] . ( a ) circular coms plaque seen above along with the corresponding circular siliastic carrier below which is loaded with the i-125 seeds . ( b ) siliastic carrier fitted in the coms plaque with the seeds on inside surface ( a - c ) models 517 , 917 and 2025 slotted gold plaques ( eyephysics , llc , los alamitos , california , usa ) along with the corresponding dummy plaques ( wire frames ) . note model 917 in the center has a notch for tumors close to optic nerve ( a ) illustration of coms plaque showing a gap between the seeds and the sclera . hence higher dose is required to reach the tumor apex which correspondingly increases the scleral dose and also to the structures distal to the apex . there is lateral overlap of the radiation from the corresponding seeds ( dark yellow ) . ( b ) slotted plaque showing the seeds closer to sclera and minimal overlap of radiation ( dark yellow ) compared to coms plaque , hence lesser dose to sclera reducing this overlap more than compensates for the anticipated  inverse - square  increase in dose to the sclera adjacent to each seed that results from the seeds being closer to the sclera ( compared to the coms plaque ) . it also reduces radiation to the structures adjacent to the plaque edges and distal to the tumor apex . barc i ocu - prosta seeds consisting of i source of dimension 4.75 mm ( l )  0.8 mm (  ) encapsulated in titanium capsules were supplied by radiopharmaceuticals division of bhabha atomic research center , mumbai . a novel method of adsorption of radioiodine ( i ) on palladium - coated silver rod these sources were encapsulated using a 50-w , neodymium : yttrium - aluminum - garnet laser welding system . the laser - welded sources were subjected to numerous checks such as visual inspection , activity measurement , swipe test , leak test , immersion test , etc . ( a ) illustration showing cross section and the dimensions of barc i-125 ocu - prosta seeds . once the basic dosimetry is done , seeds were placed into the slots of the plaque and glued to achieve a desired dose rate distribution . the typical activity used were 3 - 4 mci per seed so as to achieve treatment dose rates of 0.5 - 1.25 gy / h , with a prescription dose of 40 - 80 gy delivered in 5 - 12 consecutive days . the tumor margins were identified using transscleral illumination and indirect ophthalmoscopy . a minimum safety margin of 2 mm is maintained . then the exact distance of suture placement points from the limbus are marked with marker pen using a calliper . the dummy plaque (  cold plaque  ) is then secured with temporary knots after passing the sutures through the eye - lets . the placement of the dummy plaque is confirmed by indirect ophthalmoscopy and scleral indentation . keeping the episcleral sutures in place , the dummy plaque is then replaced with the  hot plaque  containing the radioactive seeds and then the suture knots are made permanent [ fig . 6 ] . the plaque is then removed after an appropriate time as per the dosimetry . during that time the patient is kept in an isolated room with the eye covered with a lead shield . immediately after the plaque removal , the eye this is to make sure that all the seeds have been removed and none are left behind accidently . the seeds are then unloaded by the physicist after soaking it for few minutes in acetone and sent back in a special lead container for proper disposal . ( b ) localisation of the dummy plaque being confirmed with indirect ophthalmoscopy and scleral indentation ( not shown ) . ( c )  hot plaque  with the radioactive i-125 seeds loaded shown just before insertion ( after removing the cold plaque ) . all steps of the treatment procedure were planned in advance to minimize radiation exposure of personnel . the personnel involved in this work were monitored for radiation exposure levels by thermoluminescent dosimetry ( tld ) badge . from may 2008 to january 2011 , we operated 13 eyes of 13 patients . the type of tumor with baseline tumor size is given in table 1 . baseline characteristics of the tumors of the 13 , nine were with choroidal melanomas . of these , eight were posterior while one case involved the ciliary body region . tumors with apical diameter ( ad ) < 1 mm and largest basal diameter ( lbd ) < 5 mm are called as choroidal naevus . although the precise coms size criteria were somewhat more complicated and also changed over the course of the study , generally speaking , tumous with ad between 1 and 3 mm and lbd between 5 and 16 mm are classified as small melanomas . with ad between 3 and 10 mm and lbd between 5 and 16 mm are classified as medium ( unless it is located within 2 mm from optic disc ) and tumors with ad > 10 mm and lbd > 16 mm are classified as large melanomas . the mean ad was 7.6 mm ( range 3.8 - 13.4 mm ) and mean lbd was 12.1 mm ( range 5.2 - 17.3 mm ) . the average seed strength was 3.2 mci ( range 2.88 - 3.54 mci ) and the average number of seeds used was 16.1 ( range 9 - 25 ) . the average number of days for plaque removal was 6.4 days ( range 4 - 8 days ) and the average dose rate was 0.58 gy / hour ( range 0.44 - 0.89 ) . model 2025 was used for five cases while model 917 was used for remaining four . transpupillary thermotherapy ( ttt ) was given in the three large melanomas , 2 days before plaque removal as part of the sandwich technique described by kreusel et al . in immediate postoperative period case 1 had vitreous hemorrhage with hemorrhagic choroidal detachment and case 3 had bleeding inside the tumor [ fig . 7 ] . both these complications were assumed to be due to the sharp tip of the diaphanoscope , which is the instrument used for transillumination [ fig . after these two initial complications , we did localization of posterior tumors by indirect ophthalmoscopy and scleral indentation and did not face similar complications . at the mean follow - up of 24 months ( range 10 - 43 months ) , the average ad reduced to 4.2 mm and 7.7 mm , respectively [ fig . although in both cases tumor had not increased in size , there was optic nerve infiltration in one case and other one was case 3 , which had got injured by the diaphanoscope . one case , at 3 years follow - up , was found to have optic atrophy postvitrectomy for nonresolving vitreous hemorrhage . of the seven cases , five had visual acuity of > 20/200 before brachytherapy and by last follow - up this was reduced to three [ table 2 ] . ( a ) immediate postoperative b - scan image of case one showing large posterior melanoma ( thick white arrow ) along with hemorrhagic choroidal detachment ( thin white arrow ) . ( b ) immediate postoperative fundus image of case three showing intratumoral bleed ( thin white arrow ) and track of injury ( thick white arrow ) caused by the bend tip of diaphanoscope during intraoperative transillumination above is the long bent tip of the diapanoscope used for localisation of posterior tumors with transillumination through the sclera . below is the short straight tip used for transillumimating anterior tumors through the pupil ( a ) preoperative fundus picture of posterior choroidal melanoma situated in inferior quadrant of right eye ( thick white arrow ) . ( b ) preoperative b - scan picture showing mushroom - shaped melanoma ( thick white arrow ) along with surrounding exudative retinal detachment ( thin white arrows ) . ( c ) two - year post - brachytherapy fundus picture showing smaller condensed tumor ( thick white arrow ) along with surrounding choroidal degeneration ( thin white arrows ) secondary to radiation . ( d ) two - year follow - up b - scan image showing a smaller dome shaped tumor ( thick white arrow ) with resolved retinal detachment shows pre and postoperative visual acuity of choroidal melanoma cases three eyes of three babies had retinoblastoma . all were recurrent tumors after completing six cycles of chemotherapy and several sittings of laser . the average dose given was 40 gy with the average dose rate of 0.75 gy / hr . the plaque was kept for an average of 2.5 days . case one was enucleated at 4.2 month follow - up as it developed peripheral new tumors along with vitreous hemorrhage . this tumor kept on recurring even after 13 cycles of chemotherapy and several sittings of laser . with i brachytherapy , it regressed within 2 weeks time and the child is doing extremely well at 15 months follow - up . it was situated in inferotemporal quadrant beyond the equator with exudative retinal detachment involving inferior half of retina . the dose given was 40 gy and the plaque was kept for 3 days . at 21-month follow - up , prior to brachytherapy , triple freeze thaw cryotherapy along with intravitreal injection of bevacizumab was tried without success . small , medium and large according to the size . tumors with apical diameter ( ad ) < 1 mm and largest basal diameter ( lbd ) < 5 mm are called as choroidal naevus . although the precise coms size criteria were somewhat more complicated and also changed over the course of the study , generally speaking , tumous with ad between 1 and 3 mm and lbd between 5 and 16 mm are classified as small melanomas . with ad between 3 and 10 mm and lbd between 5 and 16 mm are classified as medium ( unless it is located within 2 mm from optic disc ) and tumors with ad > 10 mm and lbd > 16 mm are classified as large melanomas . of the nine cases , six were medium sized and three were large melanomas . the mean ad was 7.6 mm ( range 3.8 - 13.4 mm ) and mean lbd was 12.1 mm ( range 5.2 - 17.3 mm ) . the average seed strength was 3.2 mci ( range 2.88 - 3.54 mci ) and the average number of seeds used was 16.1 ( range 9 - 25 ) . the average number of days for plaque removal was 6.4 days ( range 4 - 8 days ) and the average dose rate was 0.58 gy / hour ( range 0.44 - 0.89 ) . model 2025 was used for five cases while model 917 was used for remaining four . transpupillary thermotherapy ( ttt ) was given in the three large melanomas , 2 days before plaque removal as part of the sandwich technique described by kreusel et al . in immediate postoperative period case 1 had vitreous hemorrhage with hemorrhagic choroidal detachment and case 3 had bleeding inside the tumor [ fig . 7 ] . both these complications were assumed to be due to the sharp tip of the diaphanoscope , which is the instrument used for transillumination [ fig . after these two initial complications , we did localization of posterior tumors by indirect ophthalmoscopy and scleral indentation and did not face similar complications . at the mean follow - up of 24 months ( range 10 - 43 months ) , the average ad reduced to 4.2 mm and 7.7 mm , respectively [ fig . although in both cases tumor had not increased in size , there was optic nerve infiltration in one case and other one was case 3 , which had got injured by the diaphanoscope . one case , at 3 years follow - up , was found to have optic atrophy postvitrectomy for nonresolving vitreous hemorrhage . of the seven cases , five had visual acuity of > 20/200 before brachytherapy and by last follow - up this was reduced to three [ table 2 ] . ( a ) immediate postoperative b - scan image of case one showing large posterior melanoma ( thick white arrow ) along with hemorrhagic choroidal detachment ( thin white arrow ) . ( b ) immediate postoperative fundus image of case three showing intratumoral bleed ( thin white arrow ) and track of injury ( thick white arrow ) caused by the bend tip of diaphanoscope during intraoperative transillumination above is the long bent tip of the diapanoscope used for localisation of posterior tumors with transillumination through the sclera . below is the short straight tip used for transillumimating anterior tumors through the pupil ( a ) preoperative fundus picture of posterior choroidal melanoma situated in inferior quadrant of right eye ( thick white arrow ) . ( b ) preoperative b - scan picture showing mushroom - shaped melanoma ( thick white arrow ) along with surrounding exudative retinal detachment ( thin white arrows ) . ( c ) two - year post - brachytherapy fundus picture showing smaller condensed tumor ( thick white arrow ) along with surrounding choroidal degeneration ( thin white arrows ) secondary to radiation . ( d ) two - year follow - up b - scan image showing a smaller dome shaped tumor ( thick white arrow ) with resolved retinal detachment shows pre and postoperative visual acuity of choroidal melanoma cases all were recurrent tumors after completing six cycles of chemotherapy and several sittings of laser . the average dose given was 40 gy with the average dose rate of 0.75 gy / hr . the plaque was kept for an average of 2.5 days . case one was enucleated at 4.2 month follow - up as it developed peripheral new tumors along with vitreous hemorrhage . this tumor kept on recurring even after 13 cycles of chemotherapy and several sittings of laser . with i brachytherapy , it regressed within 2 weeks time and the child is doing extremely well at 15 months follow - up . it was situated in inferotemporal quadrant beyond the equator with exudative retinal detachment involving inferior half of retina . the dose given was 40 gy and the plaque was kept for 3 days . at 21-month follow - up , prior to brachytherapy , triple freeze thaw cryotherapy along with intravitreal injection of bevacizumab was tried without success . this study gives our experience and learning curve in the management choroidal melanomas , retinoblastomas and vpt with indigenous i brachytherapy . risk factors for intraocular melanoma include caucasian race , light skin or eye color , dysplastic nevus syndrome , oculodermal melanocytosis , sun exposure and occupation exposure . most patients with ocular melanoma have symptoms such as blurry vision , loss of vision , floaters , visual field loss ( as in our patients ) , growing dark spot on the iris or alteration in the size or shape of the pupil . the four radioactive isotopes most widely used in ocular oncology are iodine-125 , palladium-103 , cesium-131 and ruthenium-106 . ru plaques emit -particles that travel a relatively short distance in tissue and can not completely irradiate tumors more than 5-mm tall . several authors have reported that local tumor control rates and need for enucleation appear to be inferior with ru compared to i , especially when apical tumor height is considered.[1518 ] i for choroidal melanoma was first described by sealy in 1976 . the major advantages of this radioisotope were the ability to protect the surrounding ocular structures , including the eyelids and lacrimal system , and the decrease in radiation exposure to the surgical staff . the excellent screening characteristics , good tissue penetration , low oxygen enhancement ratio and high relative biological effectiveness make i an ideal source for local radiotherapy . finger et al . have reported on the use of pd in the united states to treat choroidal melanomas . the seeds are the same size and thus can be used in the same carrier plaque as i. cesium-131 is an x - ray emitter ( 29 kev to 34 kev ) with a half - life ~9.7days that can also be used as i. large scale production process to avail pd and cs for seed brachytherapy application has not been established in india . the indian pursuit of developing technology for i brachytherapy sources was driven mainly by three considerations , namely , ( a ) well - established production of i in several gbq quantities , ( b ) need to provide i- brachytherapy sources to meet the domestic needs and ( c ) help to promote the beneficial use of i brachytherapy sources in the country . radiation characteristics of radionuclides used in prostate seed implantation for choroidal melanomas , the local treatment failure rate in coms trial was 13% while it was 22.2% in our study . this eye received a dose rate of 0.44 gy / hr , which was the lowest dose rate in our study . although coms trial recommended a dose rate between 0.43 and 1.05 gy / hr , the american brachytherapy society recommends a dose rate between 0.6 and 1.05 gy / hr , as dose rates of less than 0.6 gy / h show lower tumor control rates . thus , this low dose rate could be a factor for poor tumor control in this patient . another eye was enucleated as along with radiation retinopathy there was a bulge from the central part of the tumor , at the site of injury by the sharp tip of the diaphanoscope . the five year all cause mortality was 19% in enucleation group and 18% for i brachytherapy group , in the coms trial . however , in our study the sample size was much smaller and final follow - up shorter compared to coms study . of the seven eyes which were analyzed for visual acuity ( va ) , three ( 50% ) had va 20/40 while two ( 28.6% ) had va 20/200 preoperatively . at mean follow - up of 24 months only one ( 14.3% ) had va 20/40 while four ( 57.1% ) had va 20/200 . in the coms trial , 70% and 10% of eyes had va 20/40 and 20/200 , respectively . three years after brachytherapy , only 31% and 41% of eyes had va 20/40 and 20/200 , respectively . moreover in our study three cases were with large tumors that would be expected to fare worse with respect to visual acuity . for retinoblastoma , merchant et al . reported a preservation rate of 60% ( 15/25 eyes ) . in our study , of the three eyes of three babies , although we had only one case of vpt in our study , it was having an ad of 4 mm with a large exudative detachment which successfully resolved after brachytherapy . thus we agree with cohen et al . that i-125 plaque radiotherapy is an effective method of treating larger ( > 2.5-mm thickness ) vpts with extensive exudative retinal detachment . barc i ocu - prosta seeds has been reported , it was based on a single case report , that too of a patient with choroidal metastasis whose long - term follow - up is questionable . thus our study is the longest series of patients treated with these indigenous seeds and it shows results which are comparable to international standards . in conclusion , episcleral plaques brachytherapy using i seeds is one of the modalities to control intraocular tumor . despite the general axiom that ocular melanomas are radiation resistant , highly concentrated radiation therapy can be successful in promoting tumor regression . while there is still a long path to travel to find the ultimate cure for ocular melanoma , the results of this institutional retrospective study represent a significant step forward in the management of intraocular melanomas in india .
context : to analyze the results of episcleral plaque brachytherapy using indigenous bhabha atomic research centre ( barc ) iodine-125 ocu - prosta seeds for the management of intraocular tumors from a single institute.aim:to report our initial experience and learning curve on the use of  barc i-125 ocu - prosta seeds for the management of intraocular tumors such as choroidal melanomas , retinoblastomas and vasoproliferative tumors ( vpt).materials and methods : we retrospectively reviewed 13 eyes of 13 patients who underwent ophthalmic brachytherapy between may 2008 to march 2012 . 
 nine cases had choroidal melanomas ; three had retinoblastomas while one case had vpt.results:for choroidal melanomas the average apical diameter before brachytherapy was 7.6 mm and average largest basal diameter was 12.1 mm , respectively , which reduced to 4.2 mm and 7.7 mm after the procedure at an average follow - up of 24 months ( range 10 - 43 months ) . 
 retinoblastoma and vpt also showed good regression after brachytherapy.conclusion:plaque radiotherapy using 125i seeds can be performed under peribulbar anesthesia and provides a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications . 
 patients in our studies experienced excellent local tumor control . with the availability of indigenous 
 barc i-125 ocu - prosta seeds locally , cost effective ophthalmic brachytherapy can be performed in india .