Intractable elevated intraocular pressure during plaque brachytherapy for posterior choroidal tumors: a case report

Introduction: Uncontrolled elevated intraocular pressure (IOP) during brachytherapy for posterior choroidal tumors is unreported. We present two patients who both experienced intractable elevated IOP during plaque brachytherapy. Case Presentations: Both patients experienced persistent elevated IOP unresponsive to all pressure-lowering agents following surgery that included transvitreal retinochoroidal biopsy and Ruthenium-106 plaque application for posterior choroidal tumors in the superior quadrants. During plaque placement in patient 1, a large, dilated vortex vein was observed in the area where the plaque was to be placed. After plaque removal in both patients, IOP normalized without the need for additional pressure-lowering therapy. Conclusion: We hypothesize that the clinical presentation in both patients was primarily attributable to two factors. First, pre-existing venous congestion, and second, the application of a plaque, which obstructed the superior vortex vein. This left the remaining vortex veins unable to compensate for the obstruction, leading to intractable IOP during plaque brachytherapy.