Learn about why not all eye plaques used for treatment of choroidal melanoma and other intraocular tumors are not equal. Dr. Finger started using palladium-103 seed sources in eye plaques back in 1991.  He recognized that palladium-103 would provide more radiation to choroidal melanomas while reaching fewer normal vital intraocular structures compared to iodine-125 seeds. This difference has translated into better local cancer destruction and better vision retention for his patients.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065 E-mail: [email protected] Telephone: (011) 212 832 8170

Vision-sparing plaque radiation can be used to destroy iris and iridociliary melanoma. The big advantage compared to surgical iris melanoma removal is that radiation doesn't require surgery that cuts into the eye to remove the tumor and margins.

Instead, a patch of radiation is sewn onto the cornea and white sclera after which the radiation extends through the eyewall and tumor. Compared to surgery, this form of radiation can treat a larger area, doesn't require removing normal iris and is less likely to cause loss of vision or loss of the eye. Though years later, radiation cataracts are common, no one has developed radiation retinopathy or optic neuropathy. Ask about Dr. Finger's Amniotic Membrane Buffer Technique to make radiation more comfortable.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065 E-mail: [email protected] Telephone: (011) 212 832 8170

Normal plaque position was defined by the American Brachytherapy Society (ABS) as covering the entire tumor and a 2-3 mm margin of normal-appearing tissue. However, the optic nerve in its sheath behind the eye is 5-6 mm wide. In order to achieve normal plaque position for any tumors that are near the 1.8 mm wide optic disc, an 8-mm slot was required to accommodate for the optic nerve sheath diameter, incorporate it into part of the plaque and thus move the plaque into ABS normal position.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065 E-mail: [email protected] Telephone: (011) 212 832 8170

Small incision surgery usually means quicker recovery. Dr. Finger has brought machine-controlled, micro-incision biopsy surgery to the eye. Utilizing a device called an aspiration-cutter as well as machine modulatable suction, the Finger-Iridectomy-Technique typically offers enough tumor-tissue for the pathologist to perform cytology, histopathology and immunohistochemistry. Dr. Finger says, “You just can’t do that with a sharp, cutting, fine-needle biopsy (FNAB) technique.” Best of all, the biopsy wound is usually so small you don’t need any stitches. Dr. Finger uses this technique for tumors of the iris, ciliary body, and orbit.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065 E-mail: [email protected] Telephone: (011) 212 832 8170

Dr. Finger believes that patients should know each doctor's track record. They are interested in surgical success rates and what happens to patients with similar or equivalent tumors. Dr. Finger agrees, so he started averaging together the outcomes of patients that returned to his office for follow up. Plus, his fellows add this data in near real-time to his web site where it can be viewed. Just go to http://eyecancer.com and on the upper right corner click, “Dr. Finger’s Success Rates. There you will be directed to information about choroidal melanoma, iris melanoma, and squamous carcinoma patients. Specifically, how often the eye and vision can be saved as well as how often the patient should expect a local cure.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street New York City, New York, USA 10065 E-mail: [email protected] Telephone: (011) 212 832 8170

Most patients can keep very close to their original visual acuity after plaque radiation therapy for intraocular melanoma. In 2006, Dr. Finger was the first to report that anti-vascular endothelial growth factor (called anti-VEGF) medications can suppress intraocular radiation damage. Like most diseases, these drugs must be given every 4-6 weeks, and like most diseases sometimes the types of these drugs must be switched or added. However, when he reported his 10-year study, 80% of patients retained close to their pre-radiation visual acuity.

Paul T. Finger, MD, FACS The New York Eye Cancer Center 115 East 61st Street new York City, New York, USA 10065

E-mail: [email protected]

Telephone: (011) 212 832 8170