Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity

Abstract

Purpose:To evaluate the benefits of intravitreal bevacizumab in patients with visually compromising radiation maculopathy following iodine-125 plaque brachytherapy for uveal melanoma.Methods:In this Institutional Review Board-approved, consecutive, retrospective study from 2006–2009 of patients maintaining 20/50 or better vision following treatment for visually compromising radiation maculopathy, patients were evaluated with spectral domain optical coherence tomography at 2–4 month intervals following plaque removal. Treatment with intra-vitreal bevacizumab commenced at the first signs of radiation vasculopathy on spectral domain optical coherence tomography with associated decreased best corrected visual acuity, followed by repeat injections for recurrent or persistent vasculopathic changes.Results:At 3 years following plaque brachytherapy, 81 of 159 (50.9%) patients treated for radiation maculopathy demonstrated 20/50 or better vision at median follow up of 36 months, which demonstrates significant improvement in vision as compared to the Collaborative Ocular Melanoma Study (P < 0.0001). These 81 patients were given a mean of five injections (range 1–17) over a mean of 17.6 months (range 1–54 months), starting at 15.8 months (range 3–50 months) after plaque brachytherapy. For those eyes that maintained 20/50 or better vision at the final follow-up, pretreatment mean best corrected visual acuity of 20/43 improved to 20/31.Conclusion:This study demonstrates that spectral domain optical coherence tomography can detect early vasculopathic changes secondary to radiation maculopathy and that prompt treatment with intravitreal bevacizumab may delay vision loss and maintain or possibly improve visual acuity in half of eyes diagnosed with radiation maculopathy. Radiation maculopathy remains a therapeutically manageable morbidity associated with radiation therapy for posterior uveal melanoma.

<p>Disaster Preparedness Impact In A Complex Ophthalmology Practice: A Review Of Patients Receiving Intravitreal Injections</p>

“…Although there cannot be a control arm for comparison in this unique review, based on previous studies assessing interval time between intravitreal injection therapy, we believe that any further delay in treatment would have significantly contributed to patients' loss of vision and/or worsening ocular anatomy. 3,4 Intravitreal injection therapy has shown to keep visual acuity and macular anatomy stable in several studies. [5][6][7] Additionally, appropriate treatment modality regarding injection intervals prior to the hurricane may have aided in improving outcomes despite the delay in therapy.…”

Long-term follow-up of anatomical and functional macular changes after a single intravitreal implant of dexamethasone 0.7 mg for radiation macular edema secondary to proton beam therapy for choroidal melanoma

“…Therefore, not surprisingly, the administration of intravitreal corticosteroids and antiangiogenic agents have shown positive effects in terms of reducing macular edema and stabilizing or improving visual function. Uncontrolled studies have demonstrated promising results in patients with RME treated with continuous intravitreal injections of anti-VEGF drugs for a mean follow-up of 38 and 54 months 20,21. Nevertheless, a minor proportion of patients treated with antiangiogenic drugs achieved higher and stable visual acuities.…”

Combination therapy with triamcinolone acetonide and bevacizumab for the treatment of severe radiation maculopathy in patients with posterior uveal melanoma

“…Our group has previously reported on another subset of patients who developed radiation maculopathy24 following I-125 plaque brachytherapy for uveal melanoma. Shah et al reported on 81 patients (50.9% of total radiation maculopathy cases) who developed visually significant radiation maculopathy and who maintained 20/50 or better vision with the early institution of intravitreal bevacizumab 24.…”

“…Shah et al reported on 81 patients (50.9% of total radiation maculopathy cases) who developed visually significant radiation maculopathy and who maintained 20/50 or better vision with the early institution of intravitreal bevacizumab 24. The study emphasized the importance of close serial monitoring of the macula with SD-OCT to ensure early identification of retinal changes, thus allowing for early and targeted treatment with anti-VEGF agents.…”