For patients with eye cancer, University of Florida Health ophthalmology specialist Gibran S. Khurshid, M.D., is sowing seeds of hope.
In Khurshid’s case, those seeds are tiny particles of radioactive iodine. Attached to a gold implant about the size of a contact lens, the “seeds” deliver tightly focused radiation to eye cancer, oruveal melanoma. Khurshid, an associate professor in the UF College of Medicine’s department of ophthalmology, began doing the procedures earlier this year.
The implant, known as a radioactive iodine plaque, is sewn onto the surface of the eye. It stays there for four days, delivering precise doses of radiation to the cancer.
For patients, a plaque can be the difference between sight and blindness.
“If you go back just 25 years, patients were having their eyes removed because they had cancer. Now, we can actually treat the cancer and preserve the eye,” Khurshid said.
Due to size and location, melanoma in the eye presents special challenges. For Khurshid and his team, that means using high-resolution ultrasound to gather the precise tumor measurements. Then, a plaque implanted with radioactive seeds delivers radiation to the melanoma. These seeds are typically half the size of a grain of rice. Gold is used for the custom-made plaques because it keeps radiation highly focused and prevents scattering.
The entire procedure is as precisely focused as the radiation itself. After locating the tumor and determining that plaque therapy is appropriate, Khurshid works with radiation oncologist Paul Okunieff, M.D., and medical physicist Jian Wu, Ph.D., to have the customized plaque made by a supplier. Radiation oncology works on the size of the eye plaque, creating a 3D treatment plan, calculating the activity of the radioactive iodine needed to deliver the proper dose and other essential tasks.
Two spots are booked 96 hours apart in an operating room. A bright light is then shined in the eye, revealing the tumor’s exact shape and borders. A “dummy” plaque is placed on the eye to establish a precise location and contact with the melanoma. It is then replaced by the radioactive plaque, which Khurshid stitches into place.
For patient Darla “Tiki” Dickerson, a freak accident led to the discovery of a 4-millimeter melanoma tumor. Late last year, she got some eye cream in her right eye. It swelled shut, so she sought help. During treatment, a doctor near her home spotted a “unique bubble” in her left eye that had been missed by another physician during an earlier appointment. A Pinellas County eye center confirmed the tumor and referred her to a South Florida hospital for treatment.
Then, there was more bad news: Her insurance wasn’t accepted at the South Florida hospital.
While searching for other options, she contacted Khurshid after recalling he had successfully treated a family member. Not only was UF Health closer to home, it also took her insurance. In late December, Khurshid surgically removed the eye tumor. On Feb. 22, he implanted the plaque to kill the deep penentrations of the tumor.
Killing off the melanoma wasn’t without side effects: Darla said her eye was red and painful after the procedure, and the stitches to attach the plaque were particularly excruciating. Surgery to address her cataracts is scheduled for September. Indeed for Darla, having eye melanoma and getting it treated was more arduous than beating breast cancer
“I have been through an unbelievable amount of pain — the worst kind you can imagine. That was the price of saving my eye and my sight,” she said.
Still, Darla believes the worst of her eye problems are in the past.
“The cancer is gone, and my faith is in my doctor. I can look through a pinhole and see, and that’s an incredible thing,” she said.
Her husband, Scott Dickerson, knew Darla’s low pain tolerance and aversion to needles would make treatment and recovery a challenge. But he also believed in his wife’s resilience and UF Health’s expertise. The Dickersons feel fortunate to have highly specialized medical treatment fairly close to their Inverness home.
“I told her, ‘If you want to save your eyeball and your sight, this is what you have to do.’ We have complete confidence in Dr. Khurshid and the whole team at UF Health,” Scott said.
Beyond Khurshid’s skill, Darla was struck by his tremendous dedication. One Saturday morning after the surgery, she called Khurshid in tears after a long night of intense pain. With his dog, Czar, in the truck, Khurshid met her at the UF Health Eye Center at The Oaks Mall — which was closed for the weekend. He plugged Darla’s tear ducts to help keep the eye moist and relieved her pain.
“I called him on his day off and the first thing he did was come and help me. That man is incredible,” Darla said.
More than a half-dozen patients have undergone ocular plaque radiation treatments so far. The level of pain and eye dryness after the plaque procedure varies among patients.
Khurshid said the therapy completes UF Health’s array of eye cancer treatment options. Those include lasers; a two-stage treatment known as photodynamic therapy that combines light energy with a drug; proton beam radiotherapy and now localized ocular plaques. The plaques are effective both as a first-line melanoma treatment and as a companion therapy in conjunction with tumor-removal surgery, according to Khurshid.
“There was something missing in our cancer-fighting arsenal,” Khurshid said. “Now, we have a full modality to treat any kind of adult eye cancer. It’s a very humbling experience when a patient’s cancer is cured.”