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East Hospital starts treating ocular melanoma patients, additionally confirming the patient pathway for treating ocular malignancies
In February 2025, the Ophthalmology Clinic at Riga East Clinical University Hospital (East Hospital) successfully initiated the treatment of melanoma for the first time, using the patient-friendly Ru-106 eye applicator, which also involves radiation. With the broadening of treatment methods and new possibilities for effectively treating uveal tract melanoma, the East Hospital has established and approved the patient pathway for treating ocular malignancies. This will enhance patient access to this treatment and, if necessary, allow for the continuation of treatment for ocular ciliary body tumors at the East Hospital in cases where that treatment has previously been initiated abroad.
The new treatment method also applies to metastatic processes in the uveal tract and the treatment of large eyelid tumors where surgical therapy is insufficient. The physicians of the clinic will use the Ru-106 eye applicator in cases of large malignant eyelid tumors when complete surgical removal of the tumor from the eyelid is challenging. In order for this procedure to be covered by state funding, the National Health Service (NHS) still needs to approve the expansion of the range of indications for the applicator’s use. This will allow patients to receive modern treatment, whilst enabling the hospital to effectively use the available treatment resources.
With the initiation of ocular melanoma surgeries at the East Hospital, a green corridor has also been established for ocular ciliary body melanoma patients, which not only provides modern treatment options but also increases access to state-funded medical services. The number of patients requiring the use of the new treatment method at the East Hospital’s Ophthalmology Clinic is expected to reach 10–15 people per year. Additionally, the East Hospital has established the patient pathway for treating ocular malignancies.
If there is suspicion of ocular ciliary body melanoma, the patient undergoes comprehensive examination within the green corridor, including abdominal CT to rule out metastases in the liver and/or other organs. “This radiation method is primarily applied when the ocular melanoma has not metastasized. If metastases are found, the treatment continues under the supervision of an oncologist-chemotherapist and an oncologist-immunologist, while the ophthalmologist monitors the patient’s condition over time,” explains Iveta Mežatuča, a surgeon at the Ophthalmology Clinic.
The procedure is carried out under general anaesthesia by locating the tumor and suturing the applicator onto the sclera which matches the size of the tumor, before the eye tumor is irradiated. For ocular melanoma, the primary treatment method is contact radiation therapy, where a radioactive silver plaque (applicator) is surgically sutured to the sclera for 3–10 days, depending on the size of the tumor. The irradiation time is calculated by a radiation physicist and therapist. The radiation dose is determined based on the duration of the applicator’s use, depending on how often and how long the applicator is applied. The time for which the applicator must remain sutured is calculated based on the size and density of the tumor. After irradiation, the applicator plaque is removed under local anaesthesia. The East Hospital uses the Ru-106 eye applicator which is gentler on the surrounding tissues and is intended for tumors no larger than five millimetres. However, the possibility of irradiating larger tumors is also individually assessed.
It should be noted that after this procedure, there is no radioactive danger to the surrounding environment. Additionally, the surgeon performing the surgery does not require any special personal protective equipment, as the radiation is minimal and precisely directed at the tumor area being irradiated. However, medical staff must wear dosimeters in accordance with the safety regulations for the operation of radiation equipment.
Symptoms of ocular melanoma vary, such as blurred vision, vision loss, or deterioration of vision in one eye, changes in the size or shape of the pupil, protrusion of the eyeball – exophthalmos or proptosis, visual field defects, subjective distortion of images, or the perception of sparks, broken lines, or spots in the eye, known as photopsia. These tumors are usually discovered accidentally, especially smaller ones. Initially, it is difficult to distinguish these tumors from retinal moles/nevi, but there are specific signs and examination methods, such as fluorescein angiography, where a contrast agent is injected into the vein and analysed to see if the blood vessels fill in a way typical for tumors. There are also small tumors that are simply monitored and photographed to track whether the tumor has a tendency to progress.
When the tumor is detected in an ultrasound examination, which is typical for ciliary body melanoma, it can be measured, making the respective calculations. However, as emphasized by Alīna Ļišņova, an ophthalmologist at the East Hospital’s Ophthalmology Clinic: “Small tumors are ‘silent’ and cause absolutely no complaints. As the tumor grows larger, the first signs are similar to those seen in cases of retinal detachment. For instance, the person might feel that the visual field is covered by a ‘curtain’ from one side. Sometimes patients complain of slight flashing or sparking in the eye, or of floating threads in front of the eye. If any of these signs occur, a visit with an ophthalmologist is urgent. At the East Hospital’s Ophthalmology Clinic, the eye care specialist will conduct a full ocular examination with pupil dilation to detect any suspicious mole or quietly progressing eye tumor in time. However, it should be noted that this is a rare condition.”
Ophthalmologists at the East Hospital reiterate that preventive screenings for eye melanoma should be carried out as follows:
- Before reaching 60 years of age – once every two years.
- After reaching 60 years of age – once a year.
- After reaching 80 years of age – once every six months.
The ophthalmologists at the East Hospital’s Ophthalmology Clinic, Iveta Mežatuča and Alīna Ļišņova, mastered the ocular melanoma treatment method at the East Tallinn Central Hospital, where they improved their skills over several years, performing surgeries under the guidance of Professor Artur Klett. Even before acquiring and certifying the radiation therapy machine and Ru-106 eye applicator, the East Hospital’s Ophthalmology Clinic held training and consultations where medical physicists shared their experience on how radiation doses are accurately calculated.
Medical professionals will have the opportunity to learn more about ocular melanoma treatment possibilities at the “Ocular Oncology” seminar for Ophthalmology Clinic specialists organised by the East Hospital’s Training Centre. The seminar will take place on 16 April 2025 from 16:00 to 19:05 in the conference hall of the Biķernieki inpatient facility or online via Zoom.
Register here or on the East Hospital’s website at: https://aslimnica.lv/profesionaliem/izglitiba/konferences/
About the East Hospital
Riga East Clinical University Hospital is the largest and strategically significant multi-profile hospital in the country. The hospital consists of five inpatient facilities – Gaiļezers, Latvian Oncology Centre, Biķernieki, Tuberculosis and Lung Disease Centre, and Latvian Infectious Diseases Centre, along with various specialised centres and clinics. The hospital provides highly specialised inpatient and secondary outpatient healthcare, offering multidisciplinary tertiary-level treatment and care in line with modern technology and medical knowledge. Approximately 80% of all cancer patients in Latvia are treated at the hospital. It serves as a practical training base for both Latvian educational institutions and foreign students, providing further education and knowledge transfer to healthcare specialists within and beyond the country. The hospital engages in scientific research and develops innovative methods for patient treatment. As the third-largest employer in the country, the hospital employs around 5000 staff members.
