Anti–Vascular Endothelial Growth Factor Bevacizumab (Avastin) for Radiation Retinopathy

Abstract

To evaluate intravitreal bevacizumab for radiation retinopathy. Methods: After plaque radiation therapy, 6 patients developed radiation retinopathy (retinal edema, hemorrhages, microangiopathy, and neovascularization). Intravitreal bevacizumab (1.25 mg in 0.05 mL) was periodically injected (every 6-8 weeks). Ophthalmic evaluations included visual acuity, ophthalmic examination, fundus photography, fluorescein angiography, and optical coherence tomography/scanning laser ophthalmoscopy (OCT/SLO) imaging. Results: No bevacizumab-related ocular or systemic adverse effects have occurred within the first 8 months of therapy. Progressive reductions in retinal hemorrhages, exudates, cotton-wool spots, and microangiopathy were documented by photography, angiography, and OCT/ SLO imaging. Decreased macular edema was the most common finding. Improvement or stabilization of visual acuity was noted in all cases. Conclusions: Intravitreal bevacizumab was tolerated, improved or maintained vision, and reduced hemorrhage and retinal edema (angiographic leakage). This study should lead to additional and longer-term studies of humanized monoclonal anti-vascular endothelial growth factor antibody therapy for radiation retinopathy.

Early anti-VEGF treatment for radiation maculopathy and optic neuropathy: lessons learned

“…Macular anatomy evaluations on the bevacizumab group suggested that maintaining CFT resulted was associated with preservation of vision. The absence of complications related to continuous, periodic, intravitreal bevacizumab therapy (up to 53 months follow up), were consistent with our prior studies [ 39 , 41 , 42 ]. Radiation retinopathy was graded using the Finger staging system for radiation retinopathy (Fig.…”

Early anti-VEGF treatment for radiation maculopathy and optic neuropathy: lessons learned

“…Macular anatomy evaluations on the bevacizumab group suggested that maintaining CFT resulted was associated with preservation of vision. The absence of complications related to continuous, periodic, intravitreal bevacizumab therapy (up to 53 months follow up), were consistent with our prior studies [ 39 , 41 , 42 ]. Radiation retinopathy was graded using the Finger staging system for radiation retinopathy (Fig.…”

Intravitreal pegaptanib sodium (Macugen®) for radiation retinopathy following episcleral plaque radiotherapy

“…In addition, there has been no recurrence and no complications from the intravitreal injection of pegaptanib sodium, even at the 6‐month follow‐up. Similar results have been reported recently using intravitreal bevacizumab, a non‐specific anti‐VEGF (Finger & Chin 2007).…”

A 12-Year Study of Slotted Palladium-103 Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve

“…10 Over this period, we have learned to treat radiation retinopathy, maculopathy, and optic neuropathy more aggressively with intravitreal anti-VEGF therapy, resulting in preservation of visual acuity. 12,31,[35][36][37] Our local control rates in the 12-year study dropped to 98.1% as compared to 100% in the 5-year study. We found that perineural extension is a risk factor for plaque failure.…”

Early anti-VEGF treatment for radiation maculopathy and optic neuropathy: lessons learned

“…Macular anatomy evaluations on the bevacizumab group suggested that maintaining CFT resulted was associated with preservation of vision. The absence of complications related to continuous, periodic, intravitreal bevacizumab therapy (up to 53 months follow up), were consistent with our prior studies [ 39 , 41 , 42 ]. Radiation retinopathy was graded using the Finger staging system for radiation retinopathy (Fig.…”

Intravitreal pegaptanib sodium (Macugen®) for radiation retinopathy following episcleral plaque radiotherapy

“…In addition, there has been no recurrence and no complications from the intravitreal injection of pegaptanib sodium, even at the 6‐month follow‐up. Similar results have been reported recently using intravitreal bevacizumab, a non‐specific anti‐VEGF (Finger & Chin 2007).…”

A 12-Year Study of Slotted Palladium-103 Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve

“…10 Over this period, we have learned to treat radiation retinopathy, maculopathy, and optic neuropathy more aggressively with intravitreal anti-VEGF therapy, resulting in preservation of visual acuity. 12,31,[35][36][37] Our local control rates in the 12-year study dropped to 98.1% as compared to 100% in the 5-year study. We found that perineural extension is a risk factor for plaque failure.…”

Early anti-VEGF treatment for radiation maculopathy and optic neuropathy: lessons learned

“…Macular anatomy evaluations on the bevacizumab group suggested that maintaining CFT resulted was associated with preservation of vision. The absence of complications related to continuous, periodic, intravitreal bevacizumab therapy (up to 53 months follow up), were consistent with our prior studies [ 39 , 41 , 42 ]. Radiation retinopathy was graded using the Finger staging system for radiation retinopathy (Fig.…”

Intravitreal pegaptanib sodium (Macugen®) for radiation retinopathy following episcleral plaque radiotherapy

“…In addition, there has been no recurrence and no complications from the intravitreal injection of pegaptanib sodium, even at the 6‐month follow‐up. Similar results have been reported recently using intravitreal bevacizumab, a non‐specific anti‐VEGF (Finger & Chin 2007).…”

A 12-Year Study of Slotted Palladium-103 Plaque Radiation Therapy for Choroidal Melanoma: Near, Touching, or Surrounding the Optic Nerve

“…10 Over this period, we have learned to treat radiation retinopathy, maculopathy, and optic neuropathy more aggressively with intravitreal anti-VEGF therapy, resulting in preservation of visual acuity. 12,31,[35][36][37] Our local control rates in the 12-year study dropped to 98.1% as compared to 100% in the 5-year study. We found that perineural extension is a risk factor for plaque failure.…”