The Use of Intravitreal Anti-VEGF and Triamcinolone in the Treatment of Radiation Papillopathy

Abstract

Background/Aims: To evaluate a treatment regimen for radiation papillopathy. Methods: This is a prospective noncomparative interventional case series of patients who developed radiation papillopathy after plaque brachytherapy for uveal melanoma. Treatment consisted of intravitreal bevacizumab (IVB) (1.25 mg in 0.05 mL) at the time of diagnosis, and 1 week later, intravitreal triamcinolone (IVK) (2.00 mg in 0.05 mL). One month later, patients again received both IVB and IVK. Patients were then switched to monotherapy with monthly IVB until the papillopathy resolved. Results: Eleven patients developed radiation papillopathy, with 9 receiving treatment. On multivariate analysis, total radiation dose to the optic nerve was the only significant predictor of papillopathy (p = 0.005). Four of nine patients presented with a significant decline in visual acuity (VA) at the time of diagnosis of papillopathy. In all 4, significant improvement was documented following treatment. Five patients did not present with a decrease in VA, and in this group, 80% remained stable with treatment. Conclusions: In this series, patients who had a precipitous drop in VA at the time of diagnosis of radiation papillopathy returned to baseline VA following this treatment algorithm. This protocol was effective at maintaining stability of VA in 80% of those who developed papillopathy but did not present with an acute drop in VA.

<p>Treatment of Radiation Retinopathy with Intravitreal Injection of Ranibizumab (Lucentis®)</p>

“…[10][11][12] The macular edema treatments with anti-VEGF (Ranibizumab) is promising, and the results depends on continuity what can increase the side effects. [13][14][15][16][17] The mechanisms of radiation protection are still the most effective in preventing radiation retinopathy, which do not have curative treatment. published pages including figures, diagrams and references.…”

Synergistic Effect of Combined Sub-Tenon Triamcinolone and Intravitreal Anti-VEGF Therapy for Uveitic Macular Edema

“… 22 Roelofs et al proceeded with intravitreal injection of TA one week before an aVEGF injection in eyes with radiation papillopathy. 37 Similar strategy was adopted in an earlier randomized controlled study for macular edema due to retinal vein occlusion. 35 A longer interval (two weeks) between aVEGF and Ozurdex injection was reported by Singer et al in patients with retinal vein occlusion.…”

The Role of Combined Therapy in the Treatment of Retinopathy and Optic Neuropathy Due to Radiotherapy in the Uveal Melanoma

“…Systemic and intravitreal corticosteroids, focal or panretinal laser photocoagulation, photodynamic therapy, intravitreal anti-VEGF agents, intravitreal or periocular triamcinolone acetonide, and hyperbaric oxygen therapy have been tried in the treatment. [6][7][8][9][10][11] They applied intravitreal anti-VEGF for at least two injections to the choroidal melanoma case who developed radiation optic neuropathy after finger and chin plaque radiotherapy treatment. Decreased optic disc edema, reported a decrease in papillary hemorrhage.…”

“…6 Roelofs et al used intravitreal anti-VEGF and triamcinolone sequentially in patients with radiation papillopathy after plate brachytherapy for uveal melanoma and reported that combined use was effective. 9 Shah et al reported that triamcinolone plays a beneficial role in patients treated with refractory or progressive retinopathy. 11 In another study, it was reported that retinal bleeding, cotton-wool patches, and retinal edema decreased or resolved up to 10 years in patients receiving long-term intravitreal anti-VEGF therapy in patients with radiation retinopathy.…”