Ultrasound determination of the relationship of radioactive plaques to the base of choroidal melanomas.

There is an assumption that radioactive plaques placed at surgery are, and will remain, in proper relationship to the base of the tumor. The plaque dose is calculated based on this assumption. In fact, factors such as loose sutures, improper diameter estimations, pressure from adjacent rectus muscles, and intervening tissue (oblique muscles) can compromise this relationship. Ultrasound provides a practical method of imaging the tumor and plaque simultaneously. The authors have used postoperative ultrasound to monitor the accuracy of iodine-125 plaque placement in nine cases. Detection of eccentrically placed and malpositioned plaques provides valuable insight which can be used to refine surgical technique. Detection of plaque tilting by oblique muscles can serve as a basis for recalculating dosage. The relationship of plaque margins to vital ocular structures such as the optic nerve can also be determined by ultrasound.