Choroidal melanoma is the most common primary intraocular malignancy in adults. The Collaborative Ocular Melanoma Study (COMS) found that for medium-sized choroidal melanoma, iodine-125 (I-125) episcleral brachytherapy compared to enucleation resulted in:

• A Significantly superior survival with brachytherapy
• B Significantly inferior survival (higher mortality) with brachytherapy
• C Higher risk of metastasis with brachytherapy due to tumor manipulation
• D Equivalent 5-year and 12-year mortality rates between brachytherapy and enucleation ✓

Explanation

The COMS medium tumor trial (primary finding) demonstrated that I-125 episcleral brachytherapy and enucleation produced equivalent survival outcomes — 5-year mortality was approximately 19% in both groups with no statistically significant difference. This landmark result validated brachytherapy as the standard globe-conserving treatment for medium choroidal melanoma, allowing organ preservation without compromising survival. There is no evidence that brachytherapy increases metastatic risk compared to enucleation.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.