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

Abstract

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.

Damage to the Superior Retinae After 30 Gy Whole-Brain Radiation

“…The authors stated that this was the lowest retinal dose of radiation documented to produce retinopathy. Hong et al 3 described a case of a 37-year-old female with breast cancer that metastasized to the brain who received 30 Gy over 10 fractions WBRT and 12 Gy local boost irradiation to the tumor bed in the right frontal area. Interestingly, the patient developed radiation retinopathy predominantly affecting the left eye; the authors suggested that shielding also be provided contralateral to the site of irradiation.…”

“…Fewer than a dozen cases of radiation retinopathy from WBRT have been reported. [3][4][5][6][7][8] Only a single case report has been published describing radiation retinopathy after a dose of 30 Gy in 10 fractions. 5 The patient was a 55-year-old female with metastatic breast carcinoma who developed vision loss 6 years after treatment.…”