Treatment of radiation retinopathy.

Chaudhuri, P R; Austin, Dale J.; Rosenthal, A R

doi:10.1136/bjo.65.9.623

Cited by 52 publications

(13 citation statements)

References 12 publications

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“…Subsequent angiographic investigations have also con firmed that the outer retina and choroidal cir culation could be implicated in the disease process, and that photocoagulation could limit some of the sight-threatening complica tions of end-stage retinopathy. 4,5,6,7,16,17 The progressive nature of radiation retino pathy has been emphasised; however, the natural course of clinical radiation retino pathy is still poorly understood, largely due to the difficulties encountered in mounting longitudinal studies in patients who are often ill, who have a poor life expectancy, and who occasionally develop corneal and lens opac ities limiting observation of the ocular fun dUS. 18 The long latent period between irradiation and development of retinopathy and the typically slow progression of micro vascular changes also make sequential analy sis of the vasculopathy difficult and hinder prospective investigations.…”

Section: Discussionmentioning

confidence: 99%

Fluorescein angiographic features, natural course and treatment of radiation retinopathy

Amoaku

Archer

1990

Eye

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SummaryFifteen patients who developed retinopathy following radiotherapy for cephalic tumours were studied by fluorescein angiography. Nine patients with unilateral or bilateral retinopathy had serial angiograms at six monthly or yearly intervals.Angiography revealed a wide range of retin;tl microvascular changes which were graded 1-4 according to the extent and degree of capillary malformation, incom petence and closure. All patients showed slow progression of retinopathy with remo delling of the affected microvasculature and increased capillary fallout and leakage to dye.The earliest retinopathic changes were capillary dilatation and closure and micro aneurysm formation. Telangiectatic-like vessels were a feature of the established ret inopathy and probably represented collateral channels which bordered sites of capillary occlusion.Two patients with progressive macular oedema and declining vision responded favourably to focal laser photocoagulation which returned a measure of competence to some residual dilated capillaries.The first fluorescein angiographic features of radiation retinopathy were described by Chee' and Gass2 who reported a microvas culopathy characterised by capillary incom petence and closure. In 1970, Hayreh3 studied three patients with choroidal melanoma treated by Cobalt 60 applicators and docu mented a wide range of angiographic changes in the retinal vasculature and outer retina. Bagan and Hollenhorst4 reported six cases of radiation retinopathy but angiographic changes were only described in one patient. Brown et al.5 reviewed the angiographic changes in the retinae of patients receiving external beam or plaque therapy for intra ocular tumours and identified vascular occlu sion as the key pathophysiological event leading to the development of radiation retinopathy.Thompson et al.6 studied seven patients with radiation retinopathy and highlighted the value of fluorescein angiography in accu rately identifying the microvascular alter ations. Ehlers and Kaae7 also used fluorescein angiography to determine the extent of retinal and choroidal vaso-occlusive changes in infants receiving radiotherapy for retinoblas toma. Lommatzsch et al. 8,9 and Tarkkanen and LaatikainenlO documented the regression of choroidal melanomas treated with Ru 106/ Rh 106 plaques using angiographic tech niques. They reported the disappearance of most choroidal and retinal vessels within the irradiated area and noted that chorioretinal

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Section: Discussionmentioning

confidence: 99%

Fluorescein angiographic features, natural course and treatment of radiation retinopathy

Amoaku

Archer

1990

Eye

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“…Laser photocoagulation is a widely used and approved treatment for macular edema caused by radiation retinopathy,18-20 but in this case, we performed injection of intravitreal triamcinolone acetonide for the treatment of macular edema resulting in decreased retinal thickness and improved the visual acuity. Cortcosteroids have been used for the treatment of cystoids macular edema as a mechanism that includes inhibition of arachidonic acid pathway, downregulation of vascular endothelial growth factor and reduction of blood-retinal barrier breakdown 21-23.…”

Section: Discussionmentioning

confidence: 97%

A Case of Radiation Retinopathy of Left Eye After Radiation Therapy of Right Brain Metastasis

Hong

Chang

2009

Korean J Ophthalmol

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A 37-year-old female, who had received modified radical mastectomy for cancer of her right breast, presented with decreased visual acuity in the left eye after radiation therapy for the management of the metastasis to her right brain 14 months ago. After ocular examination, we diagnosed her as radiation retinopathy. At the time of the first visit, the corrected best visual acuity was 0.4 in the left eye, and fundus examination revealed cotton wool spots and cystoid macular edema (CME). The findings in the right eye were normal except for cotton wool spots in the superior major arch. Fluorescein angiography (FA) showed marked telangiectasia and microaneurysms in her left eye but tiny microaneurysms in her right eye. Subsequent optical coherent tomography (OCT) showed CME. We injected intravitreal triamcinolone acetonide (TA). Two weeks after treatment, the visual acuity was improved to 0.6 and the retinal thickness was decreased. Three months later, the visual acuity in the left eye was dropped to 0.3 due to the recurrence of CME, so we injected intravitreal TA again. Five months later, visual acuity was improved to 0.5 and OCT revealed the improvement of CME. The incidence of radiation retinopathy is higher in the side nearer to radiation, but careful radiation blocking is also required on the opposite side of irradiation site considering the possibility of radiation retinopathy and careful observation is required on both sides of the eyes when performing fundus examination.

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“…Gass'4 and Chee9 reported some success on the treatment of macular exudates due to radiation retinopathy by photocoagulation. Chaudhuri et al 15 described the successful treatment of new vessels by panretinal photocoagulation. One patient in our series with proliferative retinal changes has been treated by argon laser panretinal ablation with regression of new vessels and cessation of recurring vitreous haemorrhage.…”

Section: Discussionmentioning

confidence: 99%