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

Abstract

Introduction: Radiation retinopathy is a dose-dependent complication of the retina following exposure to ionizing radiation. The objective of this prospective case-series is to determine the clinical efficacy of intravitreal aflibercept for radiation retinopathy secondary to radiotherapy for uveal melanoma in those that failed intravitreal bevacizumab treatment. Methods: A case-series of thirty patients with a mean age of 57 ± 15 years with radiation retinopathy were enrolled. Visual acuity (VA) and central foveal thickness (CFT) response to therapy were assessed with regression analyses at one month, three months, and six months following the switch to aflibercept. Results: Regression analyses showed statistically significant reduction in CFT and improvements in VA following the switch to treatment by aflibercept at one month, three months, and six months. The mean CFT improved from 476 μm ± 170 to 386 μm ± 139 and the mean VA improved minimally from 20/115 ± 20/63 to 20/112 ± 20/54 over 6 months. After six months of aflibercept, 46% of patients displayed a CFT improvement of 100 μm or greater and 23% of patients showed improvement in VA of 1 line or better. Conclusion: This pilot study suggests that patients with radiation retinopathy who have failed monthly intravitreal bevacizumab may respond to aflibercept.

Radiotherapy in Uveal Melanoma: A Review of Ocular Complications

“…Intravitreal anti-VEGF therapy (bevacizumab, ranibizumab, and aflibercept) [33][34][35][36][37] Intravitreal corticosteroids (triamcinolone acetonide and dexamethasone implant) [33] Sub-tenon triamcinolone acetonide Intravitreal fluocinolone acetonide implant [38] Retinal Detachment (RD) Observation [39] Pars plana vitrectomy [40,41] Scleral buckles [40,41] Intravitreal triamcinolone, bevacizumab [42,43] Vitreous Hemorrhage (VH) Observation [31,41] Pars plana vitrectomy (in case of recurrence or complications) [31,41] Ocular Inflammation Topical corticosteroids and cycloplegics [1,44,45] Iris Neovascularization (NVI) Panretinal photocoagulation (PRP) [1,45] Anti-VEGF therapy [46] Surgical techniques-endoresection [4,46] Secondary Glaucoma (SG) IOP-lowering medical therapy Laser treatment [47][48][49] • Cyclophotocoagulation (CPC) • YAG-iridotomy Glaucoma drainage devices [50] Neovascular Glaucoma (NVG) IOP-lowering medical therapy and glaucoma drainage devices Intravitreal or intracameral bevacizumab [4,30,51,52] Panretinal photocoagulation (PRP) [45,47,52,53] Transpupillary thermotherapy (TTT) [30,46,…”