Ocular Oncology Surgery - Eye Cancer Surgery
Most eyes with melanoma are now saved with a radioactive plaque sewn to the eye for a few days, and survival matches removal. In children, retinoblastoma is curable when found early. This guide explains uveal melanoma by size and risk, plaque radiotherapy, treatment after spread, retinoblastoma care, and how long each treatment takes in Istanbul.
About This Department
Most eyes with melanoma no longer need to be removed. A radioactive plaque sewn to the eye for a few days gives the same survival as removal, and in children with retinoblastoma the first aim is now to save life, the second to save the eye.
Eye cancers are rare. Results depend on a team that sees them regularly. Uveal melanoma, the commonest adult eye cancer, spreads more frequently the thicker it grows, from 6 percent at ten years for the thinnest tumors to half for the thickest, so the time between diagnosis and treatment matters. Doctors cure retinoblastoma in almost every child diagnosed while the tumor is still inside the eye, and once it has spread beyond the eye or into the brain the outlook changes completely. A white glow in a child's pupil in a photograph deserves an eye examination within days. Send us your scans, ultrasound and photographs, and an ocular oncologist will tell you what the tumor is likely to be, which treatment fits and how long to plan.
- Uveal melanoma, arising in the pigmented layer inside the eye, mostly in adults over fifty.
- Retinoblastoma, arising in the retina of young children, usually before age five.
- Tumors of the surface and lids, such as squamous cell cancer and melanoma of the conjunctiva, and basal cell cancer of the eyelid.
- Tumors of the orbit, the socket around the eye, including lymphoma and tumors spreading from the sinuses.
Uveal melanoma
Size decides the risk
A review of 8,033 eyes at one of the largest eye cancer services measured how frequently melanoma had spread by thickness. At ten years, metastasis had occurred in 6 percent of tumors under 1 millimeter thick, 16 percent at 3 to 4 millimeters, 27 percent at 4 to 5, 41 percent at 7 to 8, and 51 percent above 10. Older age, location in the ciliary body, a larger base, orange pigment, fluid under the retina and growth outside the eye added to the risk.
Spread goes to the liver first. It can appear years later. Every patient therefore needs liver imaging for life, every six to twelve months, whatever treatment the eye receives. Many centers also test the tumor's genetics, which sharpens the estimate of risk.
- Plaque radiotherapy. A small curved disc holding radioactive seeds, iodine-125 or ruthenium-106, is sewn to the outside of the eye over the tumor and removed after a few days. The standard for small and medium tumors.
- Proton beam or stereotactic radiotherapy. External radiation for tumors near the optic nerve or too large for a plaque, where available.
- Local removal of the tumor. For selected tumors of the iris or ciliary body, sometimes after radiation.
- Enucleation, removal of the eye. For very large tumors, painful blind eyes, or tumors growing into the optic nerve, with an implant and a custom prosthesis afterward.
Plaque or removal of the eye
For medium-sized melanoma, the Collaborative Ocular Melanoma Study randomized patients between iodine-125 plaque and removal of the eye and found no difference in survival. The choice therefore turns on what each patient values, keeping the eye and some vision, or avoiding years of checks on a treated eye that may lose sight from radiation damage.
What do the trials show for melanoma?
Survival is the same either way, and what differs is life after treatment.
Quality of life after plaque or removal
A quality-of-life study within the Collaborative Ocular Melanoma Study followed 209 patients for five years. Patients treated with a plaque reported better driving and side vision for the first two years than those whose eye was removed. The difference faded by three to five years as vision in many irradiated eyes declined.
Anxiety fell in both groups after treatment, while patients with a plaque were less likely to see their anxiety resolve, perhaps because the tumor remained in the eye and needed watching. Satisfaction with appearance and worry over recurrence did not differ after two years.
Given that no significant differences in survival between enucleation and brachytherapy have been found, the differences demonstrated here for driving and anxiety will allow the individual patient and physician to make informed choices regarding treatment based on personal preferences.Collaborative Ocular Melanoma Study quality-of-life report, Archives of Ophthalmology, 2006
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| Tumor thickness | Metastasis by ten years |
|---|---|
| Up to 1 mm | 6 percent |
| 1.1 to 3 mm | 12 percent |
| 3.1 to 4 mm | 16 percent |
| 4.1 to 7 mm | 27 to 29 percent |
| 7.1 to 8 mm | 41 percent |
| Over 8 mm | 44 to 51 percent |
Increasing millimeter thickness of uveal melanoma is associated with increasing risk for metastasis.Review of 8,033 eyes, Archives of Ophthalmology, 2009
If melanoma spreads
Tebentafusp
Metastatic uveal melanoma responds poorly to the immunotherapy used for skin melanoma. Tebentafusp, a bispecific molecule that directs T cells to melanoma cells, works in patients who carry the tissue type HLA-A*0201, close to half of people of European descent. In a randomized trial of 378 such patients, 73 percent were alive at one year against 59 percent with other treatments. The final five-year analysis, published in 2026, found 16 percent alive against 8 percent. Rash, fever and itching are common with the first doses, which are given in hospital.
What about retinoblastoma in children?
For a child with retinoblastoma, the weeks between the first sign and the first examination matter more than any technique.
Why early diagnosis decides everything
A white glow in the pupil in photographs, or a squint in a baby, is the usual first sign. Caught while it is still inside the eye, retinoblastoma is curable in almost every child. The global retinoblastoma study, covering 4,351 children from 153 countries diagnosed in 2017, showed how much depends on where a child lives. High-income countries diagnosed children at a median of 14 months, and 0.3 percent had metastasis. In low-income countries the median age was 30.5 months, 49.1 percent had tumor outside the eye and 18.9 percent had metastasis.
Treatment
Saving life first, then the eye, then sight
Laser or freezing treats small tumors. Larger ones shrink with chemotherapy, given through a vein, or through a fine catheter into the artery that feeds the eye, which concentrates the drug where it is needed. A plaque treats selected single tumors. An eye with advanced disease, or no hope of useful sight, is removed, and a child adapts well to one eye with a good prosthesis.
Every child needs a blood test for the RB1 gene. A child with the inherited form may develop tumors in the other eye and other cancers later, and brothers, sisters and future children need screening from birth. Genetic counseling belongs in the plan.
Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels.Global Retinoblastoma Study Group, JAMA Oncology, 2020
This table scrolls sideways on a narrow screen. Swipe or drag to see every column.
| High-income countries | Low-income countries | |
|---|---|---|
| Median age at diagnosis | 14.1 months | 30.5 months |
| Tumor outside the eye | 1.5 percent | 49.1 percent |
| Metastasis | 0.3 percent | 18.9 percent |
Days in Istanbul, cost and travel
Plaque radiotherapy needs a week, covering assessment, placement, the days with the plaque and removal. Enucleation needs four to five days, and the prosthesis is fitted six to eight weeks later, at home or here. Retinoblastoma treatment runs in cycles of a few days every three to four weeks. Fly once the surgeon has checked the eye. No gas is used.
Cost depends on the tumor and the treatment. Plaque radiotherapy includes the custom plaque and its radioactive seeds, two operations and the shielded hospital stay. Retinoblastoma care is billed per cycle, and the number of cycles becomes clear only once the first examinations have shown how the tumors respond, so the first quote covers the diagnosis and the first cycle and later ones follow the plan as it unfolds, without surprises for the family. Your own figure follows the free review of your scans.
One coordinator stays with you from the first message. The team works in English, Arabic, French, Russian, Serbian, Romanian and Spanish, and other languages are interpreted on request. An invitation letter naming the hospital and the surgeon goes out ten days before travel, and the international patients office arranges the transfer and a hotel for you and a companion, and for both parents when the patient is a child. Halal, vegetarian and diabetic meals are available, there is a prayer room, and a request for a female doctor is passed to the department and met wherever the rota allows. Back home, the coordinator stays reachable on the same WhatsApp number, and the report sets out the follow-up schedule, including liver imaging for melanoma. For children, the team also agrees with your local pediatric oncologist who will see the child between cycles, who will treat a fever at night, and how blood counts and examination findings pass back to Istanbul, so that nothing in a long course of treatment depends on a single phone number.
Start with the images.
- Eye photographs, ultrasound reports with tumor measurements, and any OCT or angiography.
- MRI or CT scans, and liver imaging if done.
- For a child, the family history of eye tumors and any genetic test result.
Eye cancer surgery FAQ
Will I lose my eye?
Will I keep my vision after plaque radiotherapy?
How is retinoblastoma treated?
What follow-up is needed after uveal melanoma?
How long do I stay in Istanbul?
Can my family come with me?
References
- Shields CL, Furuta M, Thangappan A, et al. Metastasis of uveal melanoma millimeter-by-millimeter in 8033 consecutive eyes. Archives of Ophthalmology. 2009;127(8):989-998.
- Melia M, Moy CS, Reynolds SM, et al. Quality of life after iodine 125 brachytherapy vs enucleation for choroidal melanoma: 5-year results from the Collaborative Ocular Melanoma Study. COMS QOLS Report No. 3. Archives of Ophthalmology. 2006;124(2):226-238.
- Nathan P, Hassel JC, Rutkowski P, et al. Overall Survival Benefit with Tebentafusp in Metastatic Uveal Melanoma. New England Journal of Medicine. 2021;385(13):1196-1206.
- Piperno-Neumann S, Rutkowski P, Hassel JC, et al. Five-year survival with tebentafusp in metastatic uveal melanoma. Annals of Oncology. 2026;37(9):1266-1277.
- Global Retinoblastoma Study Group; Fabian ID, Abdallah E, et al. Global Retinoblastoma Presentation and Analysis by National Income Level. JAMA Oncology. 2020;6(5):685-695.
Editor's note
Written by the Biruni Hospital medical editorial team. Reviewed by Sepide Sadık, Ophthalmology.
Medically reviewed by
Sepide Sadık
Ophthalmology
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