The successful treatment of retinoblastoma with x-rays was first reported by Hilgartner (1903). Subsequently Foster Moore (I929) in London and Martin and Reese (1936) in New York confirmed that ionizing radiation could destroy this type of tumour, but the very high doses of radiation used by these earlier workers frequently caused severe complications sometimes leading to the loss of the eye.From a study of the histological sections of eyes treated with radon seeds by Moore, (Ellsworth, I968; Hyman, Ellsworth, Feind, and Tretter, I968). In this paper we have reviewed all the patients with retinoblastoma seen at this Unit since I960. A total of I69 cases was seen and treated, thirty of which were not subsequently followed by us; as most of the latter had been referred from foreign countries for treatment and had subsequently returned home, they have been excluded from the analysis of results.

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Radiation damage to the retinal vascular system has been held responsible for small vessel occlusion, neovascularization, haemorrhages, and exudates when the whole eye has been involved during the course of therapeutic irradiation for the treatment of retinoblastoma (Martin and Reese, I945; Howard, i966), basal cell carcinoma of eyelids or nose, and carcinoma of the paranasal sinuses (Perrers-Taylor, Brinkley, and Reynolds, i965; Chee, I968; Gass, I968).Local radiation treatment for intraocular neoplasms was introduced by Foster Moore (1935) using radon seeds. From 1948 onwards, the physical principles established by Innes (i964), working in conjunction with Stallard, led to the development of the cobalt 6o-applicators, which are now used in many centres throughout the world, not only for the treatment of retinoblastoma but also in certain cases of malignant melanoma of the choroid (Stallard, i968).Retinal vascular complications after this form of therapy have been noted in the literature (Stallard, i96i, i966) but have received little emphasis. However, in a recent study from this unit of ocular complications associated with various types of therapeutic irradiation (MacFaul and Bedford, I 970), attention was drawn to certain vascular lesions which, in some cases, may result in loss of vision in the treated eye.The purpose of this paper is to report three cases of choroidal malignant melanoma treated with a cobalt 6o-applicator and investigated by fluorescein angiography, in which delayed visual loss was associated with retinal vascular occlusions of varying degree. Case reportsCase I, a 5o-year-old man, was first seen in June, I967, with an elevated pigmented lesion and associated serous retinal detachment in the infero-nasal quadrant of the left eye about I-5 mm. from the optic disc; the corrected visual acuity was 6/5. The right eye was normal. Fluorescence fundus angiography showed a pattern compatible with the clinical diagnosis of malignant melanoma of the choroid.On August 23, I967, a 7-5 mm. circular cobalt plaque was applied over the base of the tumour a nd left in place for 14 days, giving an estimated dose of 8,ooo r to the summit of the tumour. Over the next 2 months the serous detachment cleared completely and 6 months after treatment the

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