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      Glioma-associated radiation retinopathy treated successfully with aflibercept

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          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.

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          Most cited references 19

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          Radiation retinopathy.

          The wide spectrum of radiation retinopathic manifestations from local or external beam irradiation is described in 36 eyes. The most commonly encountered ophthalmoscopic signs of retinopathy include retinal hard exudates, hemorrhages, microaneurysms, cotton-wool spots, and telangiectases. The fluorescein angiographic hallmark of radiation-induced retinopathy is retinal capillary nonperfusion, supporting the concept that vascular decompensation is the primary mechanism in the production of radiation damage to the posterior segment.
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            Intravitreal anti-VEGF therapy for macular radiation retinopathy: a 10-year study.

            To report long-term experience with intravitreal anti-vascular endothelial growth factor treatment for radiation maculopathy.
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              Intravitreal triamcinolone acetonide for radiation maculopathy after plaque radiotherapy for choroidal melanoma.

              To evaluate the effect of intravitreal triamcinolone acetonide on patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma. In this prospective, nonrandomized, single-center case series of 31 patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, triamcinolone acetonide (4 mg/1 mL) was injected through the pars plana into the vitreous cavity using sterile technique. Status of radiation maculopathy and final visual acuity were the main outcome measures. At the time of diagnosis of choroidal melanoma, visual acuity was 20/20 to 20/50 in 90% (n = 28), 20/60 to 20/200 in 10% (n = 3), and 20/400 or worse in none of the patients. The mean radiation dose to the foveola was 5,122 cGy (median, 3,280 cGy; range, 1,000-16,100 cGy). Radiation maculopathy developed at a mean of 22 months (median, 16 months; range, 6-96 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. At the time of diagnosis of radiation maculopathy, visual acuity was 20/20 to 20/50 in 19% (6/31), 20/60 to 20/200 in 58% (18/31), and 20/400 or worse in 23% (7/31) of patients. After intravitreal injection of triamcinolone acetonide, visual acuity was stable or improved in 91% (20/22) of patients by 1 month and 45% (14/31) by 6 months. Mean foveal thickness by optical coherence tomography was 417 microm at injection and 207 microm at 1 month and 292 microm at 6 months after injection. Intravitreal triamcinolone acetonide can stabilize or improve visual acuity in some patients with radiation-induced maculopathy, but its effect might not be lasting.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                TCRM
                tcriskman
                Therapeutics and Clinical Risk Management
                Dove
                1176-6336
                1178-203X
                26 July 2019
                2019
                : 15
                : 937-941
                Affiliations
                [1 ]Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens , Athens, Greece
                [2 ]First Department of Ophthalmology, National and Kapodistrian University of Athens , Athens, Greece
                [3 ]Moorfields Eye Hospital , London, UK
                Author notes
                Correspondence: L KontomichosOphthalmiatreion Eye Hospital of Athens , 10672, Sina 2, Athens, GreeceTel +30 694 793 5616 Email dr_lucas83@ 123456yahoo.gr
                Article
                204841
                10.2147/TCRM.S204841
                6669310
                © 2019 Karagiannis et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 2, References: 21, Pages: 5
                Categories
                Case Report

                Medicine

                radiation retinopathy, aflibercept, glioma, macular edema

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