Retinal Vascular Changes in Radiation Maculopathy after Intravitreal Ranibizumab by Optical Coherence Tomography Angiography

Cennamo, Gilda; Montorio, Daniela; Bernardo, R. Correia; Farella, A.; Liuzzi, Raffaele; Breve, Maria Angelica; Reibaldi, Michele; Cennamo, Giovanni

doi:10.3390/jcm9061618

Cited by 5 publications

(3 citation statements)

References 35 publications

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“…Recently, the first prospective trials of intravitreal anti-VEGF therapy for radiation macular oedema after plaque brachytherapy have been published. 22,36,37 Our cohort received less intravitreal anti-VEGF injections than the prospective studies, with a median of 3 injections. The largest prospective study with 37 patients, by Schefler et al, achieved a BCVA of 6/12 or better in 30% and 6/60 or better in 83% at 1 year with the best outcome in the group receiving monthly injections.…”

Section: Radiation Complicationsmentioning

confidence: 99%

Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma

O’Day

Roelofs

Negretti

et al. 2022

Eye

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Background: To assess the long-term vision outcomes in patients with posteriorly located choroidal melanoma treated with ruthenium plaque brachytherapy between January 2013 and December 2015. Methods:A retrospective review was conducted on consecutive patients treated with ruthenium plaque brachytherapy for post-equatorial choroidal melanoma with available Snellen visual acuity before and after treatment, and the development and treatment of radiation complications.Results: There were 219 patients with posterior choroidal melanoma treated with ruthenium plaque brachytherapy. Median follow up was 56.5 months, range 12-81 months. Final visual acuity was ³ 6/12 in 97 (44.3%) patients, 6/12 to 6/60 in 57 (26.0%), < 6/60 in 55 (25.1%) and 10 (4.6%) eyes were enucleated. Radiation maculopathy was the most common radiation complication encountered, occurring in 53 (24.2%) patients. Of these, final visual acuity was 6/12 in 10 patients (18.9%), 6/12 to 6/60 in 26 (49.1%), < 6/60 in 16 (30.2%) and 1 eye (1.9%) was enucleated.Twenty-five (47%) with radiation maculopathy were treated with intravitreal antiangiogenic therapy, 27 (51%) were monitored and one (2%) was treated with scatter photocoagulation. Eyes treated with intravitreal anti-angiogenic therapy had better final vision than those observed or treated with retinal laser (chi-square, p= 0.04). On multivariate analysis, close proximity to the optic nerve and fovea, and large or notched plaque type was associated with final vision worse than 6/12. Conclusion:Most patients treated with ruthenium plaque brachytherapy for posterior choroidal melanoma retain 6/60 vision, with almost half retaining 6/12 vision at long term follow up.

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Section: Radiation Complicationsmentioning

confidence: 99%

Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma

O’Day

Roelofs

Negretti

et al. 2022

Eye

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“… 28 Cennamo et al (2020) also reported that when starting a monthly IVR for patients with RM, there was a thinning in CMT but no significant improvement in FAZ area, retinal VD, and BCVA. 29 Given that anti-VEGF agent acts on the vascular permeability and affects the retinal exudation rather than the vascular blood flow, it may fail to improve the injured retinal vascular network, which translates into VA stabilization. This finding suggests that those with advanced disease (ie FAZ area has enlarged and/or retinal VD has decreased due to retinal ischemia following radiotherapy) are more likely to tolerate treatment compared to those with early stage.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Prophylactic Anti-VEGF in Preventing Radiation Retinopathy: A Systematic Review and Meta-Analysis

Victor,

Andayani,

Djatikusumo

et al. 2023

OPTH

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Background In patients predisposed to radiation retinopathy (RR), administration of therapy after apparent clinical signs and symptoms are considered too late, resulting in substantial vision loss and blindness. Early initiation of anti-vascular endothelial growth factor (anti-VEGF) might serve as a strategy to slow disease progression and prolong good eyesight. Objective To evaluate the efficacy of prophylactic anti-VEGF in preventing RR and preserving vision in patients at high risk of radiation-induced vision loss. Methods A systematic literature search was performed from inception to 4 June 2023 using Cochrane Library, EMBASE, PubMed (MEDLINE), and Scopus. Eligible studies were clinical trials and observational studies investigating the incidence of radiation maculopathy (RM), radiation optic neuropathy (RON), moderate vision loss (loss of more than or equal to 3 lines of baseline visual acuity [VA]) and final VA, whether good (20/40 or better) or poor (20/200 or worse), following prophylactic anti-VEGF. Three reviewers independently conducted article screening, data extraction and risk of bias assessment. Random effects models were used to determine the cumulative effects of each outcome. Results Four studies (one clinical trial and three observational studies), involving 2109 patients, were included in our analysis. Across all studies, there were significant reductions in the events of RM (pooled odds ratio [OR] 0.50; 95% CI, 0.34–0.74; p = 0.001), RON (pooled OR 0.62; 95% CI, 0.42–0.90; p = 0.012) and poor final VA (pooled OR 0.50; 95% CI, 0.37–0.68; p = 0.003). The association of moderate vision loss and good final VA with the use of prophylactic anti-VEGF between the groups was unclear owing to the high level of heterogeneity. Conclusion Prophylactic anti-VEGF therapy might delay RM and RON, preventing high-risk patients from developing poor VA by approximately 50%. However, this evidence should be interpreted with caution because of its low level of certainty. Future robust studies are warranted to confirm this finding.

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“…Radiation optic neuropathy is less common than radiation maculopathy, and its rate was 10% and 12% after 2 and 3 years, respectively, while iris neovascularization was detected in 12% of the irradiated eyes after treatment ( 33 ). Motility disorders and vitreous hemorrhage occur rarely, and they are often temporary ( 33 , 39 ).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy

et al. 2022

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Uveal melanoma is the most common primary intraocular malignancy. The aim of this retrospective study was to report the results after ruthenium-106 (Ru-106) plaque brachytherapy for uveal melanoma in terms of tumor control, visual acuity, radiation-related complications, tumor recurrence, metastases, and patients’ survival rate during 4 years’ follow-up. A total of 355 eyes from 355 patients have been treated with Ru-106 plaque brachytherapy for uveal melanoma between February 2011 and March 2020. Five patients were lost to follow-up, and then 350 eyes of 350 patients (mean age 58 ± 11 years) were enrolled in this retrospective study. All patients underwent a complete ophthalmic examination including echography and spectral domain–optical coherence tomography. The mean follow-up was 4 years (3 months to 9 years). After treatment, the mean tumor thickness was reduced to 1.75 ± 0.21 mm. Radiation complications were found in 63% of patients: 38% showed radiation maculopathy, 11% had optic neuropathy, and 14% developed cataracts. Cancer-free survival was 99%, 97%, and 85%, respectively, at 5, 7, and 9 years. Ru-106 plaque brachytherapy represents a reliable treatment of uveal melanoma. This technique is valid and safe with a low rate of ocular complications during a long-term follow-up.

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Retinal Vascular Changes in Radiation Maculopathy after Intravitreal Ranibizumab by Optical Coherence Tomography Angiography

Cited by 5 publications

References 35 publications

Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma

Long-term visual outcomes after ruthenium plaque brachytherapy for posterior choroidal melanoma

Efficacy of Prophylactic Anti-VEGF in Preventing Radiation Retinopathy: A Systematic Review and Meta-Analysis

Long-Term Outcomes in Uveal Melanoma After Ruthenium-106 Brachytherapy

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