Plaque surgical techniques are rarely described in the literature. 1-6 When available, they are typically found in the methods sections of papers describing a new radiation source or plaque position verification technique.3,7-14 This understates their importance in that our surgical methods affect the incidence of secondary radiation complications, local control, and thus metastasis.1,15-17 Plaque modality, construction, and medical physics calculations are critical foundational elements of treatment success.4,18-20 Significant research indicates that failure of local control is associated with a 6.3x hazard for metastatic disease.15,21 My techniques have been refined over the last 35 years, leading to a current local control rate greater than 99% as measured by doctor-reported outcomes.22,23 Herein, I offer my thoughts, methods, and experience with surgical ophthalmic plaque radiation therapy. The lack of consensus guidance is related to the complexity of plaque therapy. For example, there exist a variety of radiation plaque modalities: palladium-103 (103Pd), iodine-125 (125I), ruthenium-106 (106Ru), strontium-90 (90Sr), and most recently yttrium-90 (90Y).24-28 In addition, ophthalmic plaques come in different shapes and sizes.18,20 Although the American Brachytherapy Society (ABS) together with the American Association of Physicists in Medicine (AAPM) have published guidelines for ophthalmic plaque brachytherapy for choroidal melanoma and RB, there exist nuances that were beyond the scope of that multicenter, international effort.18,29 Intraocular tumors also occur at different intraocular locations.30 Clearly, epicorneal plaque positioning differs from that on the posterior pole, particularly due to optic nerve sheath obstruction.6,17,31,32 However, there are commonalities and differences that need be described to improve ophthalmic plaque surgery.