Radiosurgery in ocular disorders: clinical applications.

Radiosurgery using the Leksell Gamma Knife (LGK) applied to ophthalmologic indications is a specific area where the eye target has a very eccentric location, since the eye can move, its fixation is required and the patient is generally treated in a prone position. It was demonstrated that the LGK is sufficiently accurate to be used for ophthalmic radiosurgery. Current spectrum of treated indications includes uveal melanomas, eye metastases, advanced glaucoma, age-related macular degeneration (ARMD), hemangioblastoma, angioreticuloma, pseudotumors and vegetative pain. The results for uveal melanomas are recognized and the value of the LGK in the treatment of glaucoma and ARMD seems promising after initial studies. Gamma Knife radiosurgery of the ciliary body leads to a significant alleviation of pain and reduction in intraocular pressure in advanced glaucoma. The latency of the treatment effect is relatively short. In the majority of patients with ARMD, both ultrasonography and fluorescein angiography demonstrated a regression of the neovascular complex or stabilization after LGK radiosurgery. A number of rare ophthalmologic indications have also been treated by the Gamma Knife in our Center with more or less prominent therapeutic responses.