*4.3.4 Management*

The most common treatment modality is the episceral plaque brachytherapy. Plaque brachytherapy is suitable for tumors up to 16 mm in diameter and up to 6 mm thickness with Ruthenium-106 and up to 8 mm thickness with Iodine-125. The dose to the tumor apex should be 10,000 cGy and almost up to 90% tumor control can be achieved. Enucleation is an option for tumors beyond the scope of plaque brachytherapy. Orbital exenteration might be required in tumors with orbital invasion. The proton beam irradiation has a higher chance of eye salvage but the availability and affordability are the considerable limitations. The other treatment modalities include laser photocoagulation, transpupillary thermotherapy, chemotherapy, and immunotherapy.

The various newer treatment modalities under evaluation are:


3. Immunotherapy with Ipilimumab with nivolumab.
