{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:41:18Z","timestamp":1786650078147,"version":"build-2736575974"},"reference-count":6,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,8]]},"abstract":"\n Background:<\/jats:title>\n \n Anterior segment tumors are rare tumors with limited management options. In small-sized lesions, plaque brachytherapy is advisable. The placement techniques of plaques for anterior segment tumors are completely different from the techniques for posterior segment tumors.\n [1-4]<\/jats:sup>\n In cases where the lesion is located in the medial, lateral, or inferior iris, the possibility of tilt or displacement of the plaque is higher. The gravitational pull, coupled with ocular movements, squeezes the plaque against the ocular surface and the eyelid. This leads to displacement of the plaque along with damage to the corneal epithelium. Although certain novel plaque designs have been described in the literature to prevent such complications.\n [5]<\/jats:sup>\n Their regular availability in all brachytherapy units is limited.\n <\/jats:p>\n <\/jats:sec>\n \n Purpose:<\/jats:title>\n The authors here demonstrate a novel technique of \u201cTriple support pocket\u201d in a case of inferior irido-ciliary melanoma.<\/jats:p>\n <\/jats:sec>\n \n Synopsis:<\/jats:title>\n \n The video demonstrates the steps of the \u201ctriple support pocket\u201d orientation of brachytherapy plaque placement, along with a surgical demonstration in a case of inferior irido-ciliary melanoma. The steps include first sectoral peritomy with conjunctival dissection and flap creation, followed by step 2, which involves placement of a figure of 8 pattern 5\u20130 ethibond suture. The points of suture entry and exit are determined by the size of the plaque. The entries and exits are 0.5\u20131 mm away from the plaque edge. The third step involves moving the conjunctival flap over the brachytherapy plaque. The fourth step is where a tarsorrhaphy is performed. A 42-year-old female patient presented with an inferior iris lesion, which was diagnosed as an irido-ciliary melanoma using the popular \u201cABCDEF\u201d rule designed by Shield\n et al.<\/jats:italic>\n [6]<\/jats:sup>\n The tumor had a largest basal diameter of 7.32 mm and an apical thickness of 3.87 mm extending inferiorly from 6\u2019o clock to 7\u2019o clock. A radio-active Ruthenium 106 plaque of size 12 mm was used in the management. Centration was achieved by using ultrasound on the table. Care was taken to ensure that all the edges of the tumor is covered, and the center of the plaque corresponds to the maximum apical thickness. The authors have performed this procedure twice, and there has been no incidence of tilt of plaque or displacement. The mean duration of the two cases was 119.5 hours. Mean dose at the sclera and apex is 313 Gy and 80 Gy, respectively. At 3 months follow-up, there were no cornea-related side effects or glaucoma.\n <\/jats:p>\n <\/jats:sec>\n \n Highlights:<\/jats:title>\n Triple support pocket orientation of plaque brachytherapy helps in the prevention of displacement or tilt of the brachytherapy plaque.<\/jats:p>\n <\/jats:sec>\n \n Video Link:<\/jats:title>\n https:\/\/youtu.be\/6G2wIiCbteE<\/jats:p>\n <\/jats:sec>","DOI":"10.4103\/ijo.ijo_24_25","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T15:00:32Z","timestamp":1753714832000},"page":"1239-1240","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["\u201cTriple support pocket\u201d for placing brachytherapy plaques for anterior segment tumors"],"prefix":"10.4103","volume":"73","author":[{"given":"Neiwete","family":"Lomi","sequence":"first","affiliation":[{"name":"Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepsekhar","family":"Das","sequence":"additional","affiliation":[{"name":"Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavna","family":"Chawla","sequence":"additional","affiliation":[{"name":"Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Niranjana","sequence":"additional","affiliation":[{"name":"Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhanabalan","family":"Rajasekaran","sequence":"additional","affiliation":[{"name":"Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radhika","family":"Tandon","sequence":"additional","affiliation":[{"name":"Dr R P Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"912","DOI":"10.4103\/IJO.IJO_824_23","article-title":"Anterior plaque brachytherapy placement for treatment of iris and iridociliary melanomas - Surgical procedure and institutional experience","volume":"72","author":"Pike","year":"2024","journal-title":"Indian J Ophthalmol"},{"key":"R2-20260421","doi-asserted-by":"crossref","first-page":"303","DOI":"10.4103\/IJO.IJO_2213_23","article-title":"Disinsert, retract and rotate technique of plaque brachytherapy","volume":"72","author":"Lomi","year":"2024","journal-title":"Indian J Ophthalmol"},{"key":"R3-20260421","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1001\/archopht.126.4.531","article-title":"Finger\u2019s amniotic membrane buffer technique: Protecting the cornea during radiation plaque therapy","volume":"126","author":"Finger","year":"2008","journal-title":"Arch Ophthalmol"},{"key":"R4-20260421","doi-asserted-by":"crossref","first-page":"303","DOI":"10.4103\/IJO.IJO_2207_23","article-title":"Inferior oblique sparing brachytherapy plaque placement for juxtafoveal peripapillary choroidal melanoma","volume":"73","author":"Lomi","year":"2025","journal-title":"Indian J Ophthalmol"},{"key":"R5-20260421","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1159\/000493269","article-title":"Novel eye plaque designs for brachytherapy of iris and ciliary body melanoma and the first clinical application","volume":"5","author":"Liu","year":"2019","journal-title":"Ocul Oncol Pathol"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"159","DOI":"10.4103\/0974-620X.122269","article-title":"Review of cystic and solid tumors of the iris","volume":"6","author":"Shields","year":"2013","journal-title":"Oman J Ophthalmol"}],"container-title":["Indian Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_24_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:01:47Z","timestamp":1786647707000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/IJO.IJO_24_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,28]]},"references-count":6,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ijo.ijo_24_25","relation":{},"ISSN":["0301-4738","1998-3689"],"issn-type":[{"value":"0301-4738","type":"print"},{"value":"1998-3689","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,28]]}}}