**2. 3D printing in ophthalmology**

3D printing was introduced to medicine at the beginning of this century, when the technology was first used to create dental implants and individualized prosthetics. Since then, the medical applications for 3D printing technology have progressed significantly. The first published reviews describe the importance, utilization and results of 3D printing when applied in the field of orthopedic surgery, cardiovascular surgery, and tissue engineering, as well as in pharmaceutical development (new dosage forms, delivery of medicines, etc.). The current medical application of 3D printing technology is classified into several groups, such as prosthetics, implantation, and precise anatomical models; production of tissues and organs; and research in pharmaceutical industry on drug discovery, design of dispensers, and drug dosage forms [4].

#### **2.1. 3D printing for eyewear and medical devices**

3D printing technology has progressed to the point when companies print custom-made eyewear with their own design and on demand. The market for customization of eyewear has been made possible by a rapid prototyping. 3D printing enables and simplifies on demand production of medical devices in plastic or metallic form, and in the future, may represent the best way to produce artificial lenses, glaucoma valves and other personalized implants.

#### **2.2. For education and clinical practice**

3D printed models are already used in institutions for medical education—due to their accurate visualization are being used to introduce surgical techniques to trainees, young doctors or students before they start to treat patients. Surgical simulations using 3D models allow students to practice in a safe environment, until they can perform the techniques at the expected level. Hypothesis that these models can shorten the learning curve, standardize training and assessment, became true. The results show that trainers using 3D printed models have done a lot to finish their tasks better and have a better learning experience than those who used only digital models or textbooks. This suggests that using 3D models enhances the understanding of anatomical structures, their collocations, and their relationships. With the advancement of 3D printing technology, the 3D print models can be made available to improve the training of young ophthalmologists in a simulated operating theater environment, thus improving the training experience.

It will provide a better possibility and learning experience for the doctors, physicists and

3D Printing Planning Stereotactic Radiosurgery in Uveal Melanoma Patients

http://dx.doi.org/10.5772/intechopen.79032

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We introduced the 3D printing technology into a process of planning stereotactic radiosur-

Intraocular melanoma is a quite rare type of cancer and is a disease in which tumor cells are formed in the part of the eye globe called the uvea (iris, ciliary body and choroid). Intermediate layer of the eye globe (uvea) contains melanocytes. Process of melanogenesis leads to produce

There are some cases in which doctors have detected intraocular melanoma during a routine eye globe examination. The chance of recovery depends on factors such as the size and cell type of the tumor. In support of classification, the staging system tumor node metastasis (TNM) is used for standardization of the tumors so the care teams can summarize information about how a tumor has spread. The information about the TNM classification is combined by a process called stage grouping. For example, intraocular melanoma grade T4 (due to clas-

Uveal melanoma is relatively rare type of cancer, but the most common and most aggressive type of intraocular tumor in adults. The incidence of intraocular tumors varies from 0.2 to 1.0.

Most people with intraocular melanoma experience no symptoms of the disease in its early

gery (SRS) in patients as a treatment of intraocular tumor—uveal melanoma [5, 6].

surgeons [4].

**3.1. Definition**

**3. Intraocular melanoma**

**3.2. Signs and symptoms**

• A growing dark spot on the iris.

• Change in the size or shape of the pupil.

stages.

melanin (can be found also in hair and in skin).

sification) spreads to the orbit and extraocular tissues.

Uveal melanoma mostly occurs in middle-aged people [7, 8].

As the disease progresses, the following signs and symptoms can be seen:

• Floaters (spots or squiggles drifting in the field of vision) or flashes of light.

• Problems with vision (blurry vision or sudden loss of vision).

• Visual field loss (losing part of your field of sight).

• Increased intraocular pressure (secondary glaucoma).

• Change in the way the eye globe moves within the socket.

#### **2.3. For printing of live cells, tissues, and organs**

The development of 3D bioprinting technology, including the printing of living cells, different tissues, and even organs, is now becoming an important and expanding field of medical research. From 2012, this technology has been studied in academic circles and by biotechnology corporations (e.g., Organovo Co., San Diego, CA, USA) for possible use in tissue engineering applications, where tissues and organs are created by using 3D inkjet printing technology. The technology process is based on placing living cells onto a gel medium or sugar matrix and layer-by-layer predefined 3D structures are formed. In this way, blood vessels, bones, ears and other structures can be printed. Using 3D bioprinting technology in 2014, researchers successfully implemented a 3D skull component into a patient, with no adverse effects. This new technology represents an extension of the treatment options for creating and adapting personalized implants to the patient. The use of three-dimensional bioprinting in ophthalmology is, however, still limited, but for the generation of ocular tissues (e.g., conjunctiva, sclera, and corneas), the use of 3D bioprinting technology in the future has a great potential.

#### **2.4. For surgical planning**

In the first place, the ophthalmologist must comprehend complicated anatomical structures of the eye globe and orbit and their connection with the suspected lesion. Structural relationships observed and defined between orbital structures, muscles, vessels, and nerves can be difficult to assess fully during the planning of the orbital surgery, based solely on the 2D scans obtained. The small surgical access field for eye globe (diameter 24 mm) also means that any mistake in navigating in this structures and complicated anatomy can have potentially devastating consequences for the patient—postradiation complications. Experience proves that, for both practical and educational purposes, the creation of an anatomically personalized organ models by using 3D printing technology is very useful. This technology allows a full appreciation of anatomical relationships and collocation between tumors or lesions and other complicated surrounding, but healthy structures. Advances in 3D printing technology enable the real prototyping of various anatomical structures and allow accurate representation of the patient's current state. In surgical or irradiation planning schemes in human medicine, it will be an invaluable aid to have this real 3D organ models. It will provide a better possibility and learning experience for the doctors, physicists and surgeons [4].

We introduced the 3D printing technology into a process of planning stereotactic radiosurgery (SRS) in patients as a treatment of intraocular tumor—uveal melanoma [5, 6].
