Palladium-103 brachytherapy with continuous periodic intravitreal Anti-VEGF bevacizumab for ciliary body medulloepithelioma
- 1Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, 115 East 61st Street, New York City, NY, 10065, USA
- 2Department of Ophthalmology, Tulane University School of Medicine, 131 S. Robertson St, 12th Floor, Mail Code 8069, New Orleans, LA, 70112-2632, USA; Corresponding author. The New York Eye Cancer Center, 115 East 61st Street, Suite 5A/B, New York, NY, 10065, USA.
Abstract
Purpose: To report a case of medulloepithelioma treated with palladium-103 ( 103 Pd) plaque brachytherapy, followed by adjunctive continuous periodic intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy, highlighting a novel combined strategy for tumor control and management of its neovascular complications. Observations: A 9-year-old male presented with a ciliary body mass causing anterior displacement of the iris and iris neovascularization in the right eye. Initial tumor dimensions were 8 × 8 mm in basal diameters and 3.9 mm in thickness. Aspiration cutter–assisted biopsy was used to confirm the diagnosis of medulloepithelioma. Treatment involved temporary placement of a 14-mm 103 Pd plaque, which irradiated the tumor's apex to 101.4 Gy (Gy) over 7 days. Despite tumor control, progressive iris neovascularization with secondary angle-closure glaucoma was managed by continuous periodic intravitreal anti-VEGF pharmacotherapy and two peripheral iridotomies. At 18 months post-plaque brachytherapy, a posterior subcapsular cataract developed that required extraction with intraocular lens placement. At 5 years post-plaque brachytherapy, a macular epiretinal membrane developed that was pealed during pars plana vitrectomy surgery. At 6 years 2 months follow-up post-plaque brachytherapy the tumor's thickness had decreased from 3.9 to 2.1 mm (46.2%) and the visual acuity had declined from 20/20 to 20/63. No metastases were detected. Conclusions and importance: 103 Pd plaque brachytherapy was used to control a ciliary body medulloepithelioma. However, iridotomies and continuous periodic anti-VEGF therapy were needed to suppress tumor-related secondary neovascular glaucoma. This approach achieved durable local tumor control while preserving the globe and functional vision. Targeted radiation and pharmacologic neovascular suppression offered a novel globe and vision-sparing treatment for medulloepithelioma.
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BibTeX
@article{wingate2026palladium103,
title = {{Palladium-103 brachytherapy with continuous periodic intravitreal Anti-VEGF bevacizumab for ciliary body medulloepithelioma}},
author = {Skylar L. Wingate and Paul T. Finger},
journal = {American Journal of Ophthalmology Case Reports},
year = {2026},
month = oct,
doi = {10.1016/j.ajoc.2026.102692},
url = {https://doi.org/10.1016/j.ajoc.2026.102692},
note = {CC BY},
}
RIS
TY - JOUR
TI - Palladium-103 brachytherapy with continuous periodic intravitreal Anti-VEGF bevacizumab for ciliary body medulloepithelioma
AU - Skylar L. Wingate
AU - Paul T. Finger
PY - 2026
DA - 2026/10/31
JO - American Journal of Ophthalmology Case Reports
DO - 10.1016/j.ajoc.2026.102692
UR - https://doi.org/10.1016/j.ajoc.2026.102692
AB - Purpose: To report a case of medulloepithelioma treated with palladium-103 ( 103 Pd) plaque brachytherapy, followed by adjunctive continuous periodic intravitreal anti–vascular endothelial growth factor (anti-VEGF) therapy, highlighting a novel combined strategy for tumor control and management of its neovascular complications. Observations: A 9-year-old male presented with a ciliary body mass causing anterior displacement of the iris and iris neovascularization in the right eye. Initial tumor dimensions were 8 × 8 mm in basal diameters and 3.9 mm in thickness. Aspiration cutter–assisted biopsy was used to confirm the diagnosis of medulloepithelioma. Treatment involved temporary placement of a 14-mm 103 Pd plaque, which irradiated the tumor's apex to 101.4 Gy (Gy) over 7 days. Despite tumor control, progressive iris neovascularization with secondary angle-closure glaucoma was managed by continuous periodic intravitreal anti-VEGF pharmacotherapy and two peripheral iridotomies. At 18 months post-plaque brachytherapy, a posterior subcapsular cataract developed that required extraction with intraocular lens placement. At 5 years post-plaque brachytherapy, a macular epiretinal membrane developed that was pealed during pars plana vitrectomy surgery. At 6 years 2 months follow-up post-plaque brachytherapy the tumor's thickness had decreased from 3.9 to 2.1 mm (46.2%) and the visual acuity had declined from 20/20 to 20/63. No metastases were detected. Conclusions and importance: 103 Pd plaque brachytherapy was used to control a ciliary body medulloepithelioma. However, iridotomies and continuous periodic anti-VEGF therapy were needed to suppress tumor-related secondary neovascular glaucoma. This approach achieved durable local tumor control while preserving the globe and functional vision. Targeted radiation and pharmacologic neovascular suppression offered a novel globe and vision-sparing treatment for medulloepithelioma.
SN - 2451-9936
ER -