<p>Glioma-associated radiation retinopathy treated successfully with aflibercept</p>

Abstract

Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as intraocular tumors, such as uveal melanoma and retinoblastoma. Several treatment modalities have been reported including intravitreal corticosteroids, intravitreal anti-VEGFs and argon laser photocoagulation. Our purpose is to present a case report of bilateral radiation retinopathy with macular edema in one eye that was revealed 6 years after glioma therapy and treated successfully by using monotherapy of aflibercept. A 59-year-old male patient presented with gradually deteriorating visual acuity in his left eye for the past 12 months. Best corrected visual acuity in his right eye was 20/25 and in his left eye 20/100. Fundoscopy and fluorescein angiography revealed severe non-proliferative retinopathy in his right eye and proliferative retinopathy in his left eye with macular edema. Following complete work-up and due to his past medical history, he was diagnosed with radiation retinopathy. The patient received 6 intravitreal injections of aflibercept in a period of 9 months in order to treat macular edema and radiation retinopathy. According to the literature, there is minimal experience using aflibercept monotherapy to successfully treat macular edema due to radiation retinopathy. In addition, radiotherapy for glioma is a rather rare cause of radiation retinopathy compared to other more common causes, such as nasopharyngeal tumors, meningiomas, and uveal melanomas.

Outcomes of Second-Line Intravitreal Anti-VEGF Switch Therapy in Radiation Retinopathy Secondary to Uveal Melanoma: Moving from Bevacizumab to Aflibercept

“…In 2017, Pooprasert et al [35] demonstrated improvement in radiation retinopathy in a single case of radiation retinopathy. In 2019, Karagiannis et al [32] utilized primary intravitreal aflibercept and demonstrated improvement in a patient with bilateral peripheral radiation retinopathy and unilateral maculopathy presumed to be related to external beam radiotherapy of an optic nerve glioma. Fallico et al [33], in 2019, utilized intravitreal aflibercept as a primary treatment of 9 patients with radiation maculopathy secondary to treatment of uveal melanoma with ruthenium-106.…”

“…Recently, limited information on the use of intravitreal aflibercept has also shown anatomical and functional benefits. Aflibercept is a human recombinant fusion protein that is extensively used for diabetic macular edema, macular degeneration, central and branch retinal vein occlusions, and other sources of neovascularization within the eye [32][33][34][35].…”