Figure 4.

Ruthenium brachytheraphy for invasive squamous cell carcinoma of the conjunctiva. Part (A): A 71 year-old man affected by invasive squamous cell carcinoma of the conjunctiva in the right eye that aggressively recurred shortly after a partial excision with scleral lamellectomy and cryotherapy done at a local hospital. In the attempt to save the globe, he was treated with surgical excision, Ruthenium-106 brachitherapy, and ocular surface reconstruction with amniotic membrane graft. Part (B): One-month after surgery, the amniotic membrane had been completely reabsorbed and the patient was treated with two courses of adjuvant 5-FU and intensive topical lubrification and soft steroids with slow tapering. Part (C): Two years after treatment, the eye is preserved with a 20/20 vision with no signs of recurrence. Note the scleral thinning, well covered by tenon and conjunctiva, in the area of previous full-thickness tumour invasion. This area is being monitored by means of anterior segment optical coherence tomography to exclude its evolution. In such case, a wide scleral patch would be indicated.