Treatment of radiation maculopathy and radiation-induced macular edema: A systematic review

Fallico, Matteo; Chronopoulos, Argyrios; Schutz, James Scott; Reibaldi, Michele

doi:10.1016/j.survophthal.2020.08.007

Cited by 27 publications

(30 citation statements)

References 61 publications

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“…Moreover, injuries to the corpus callosum were recently shown to be associated with attention/processing speed decline after radiotherapy [30,31]. Second, the macula and the optics tracts were added in order to allow for studying their role with regards to visual toxicity [36]. Third, the periventricular space was added as a result of accumulating data pointing to the development of radiation-induced lesions in this region after particle therapy [9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Eekers

Perri

Roelofs

et al. 2021

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 99%

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Eekers

Perri

Roelofs

et al. 2021

Radiotherapy and Oncology

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“…94 The encouraging results from the previous studies favor the role of intravitreal anti-VEGF and steroids for the treatment of radiation maculopathy, and thus can be considered as a first-line treatment. 95 The results appear to be better if treatment is continued for a longer duration with injection intervals shorter than 90 days. A more intensive treatment regimen, with the help of combination therapy, may be required in more aggressive forms of the disease.…”

Section: Recalcitrant Edemamentioning

confidence: 99%

“…However, dexamethasone implants, in general, have a lower risk of these complications and have the added benefit of slow release of the drug that can act for up to 6 months (resulting in a lesser number of injections). 95 Nonetheless, studies comparing intravitreal anti-VEGF agents with steroids have found no difference in efficacy. 96 Focal or grid laser, although rarely performed in the current era, can be used in selective cases of recalcitrant macular edema.…”

Section: Treatmentmentioning

confidence: 99%

“…Prophylaxis with anti-VEGF agents, steroids or laser, is another extensively studied aspect of RM. 95 Finger and Kurli reported the use of prophylactic pan-retinal photocoagulation and reported that only (19%) of the patients developed retinopathy at the end of follow-up. 97 Reports by Shah et al 98 and Shields et al 99 showed significant benefits in eyes that received intravitreal bevacizumab at the time of plaque removal and every 4 months for 2 years.…”

Section: Treatmentmentioning

confidence: 99%

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Radiation Retinopathy: Detection and Management Strategies

Sahoo¹,

Ranjan²,

Tyagi³

et al. 2021

OPTH

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A gradual shift in trend from primary enucleation to globe salvaging radiation therapy for the management of ocular tumors has resulted in the rise of several posttreatment ocular complications including radiation retinopathy. Radiation retinopathy is a chronic, progressive, and occlusive vasculopathy that can manifest anytime between 1 month to 15 years after starting radiation therapy. The aim of treatment in most of these cases is to prevent further vision loss. Treatment options such as laser photocoagulation, antivascular endothelial growth factor and intraviral steroids have been described. However, despite several advances in diagnostic and therapeutic modalities, a significant proportion of eyes with radiation retinopathy eventually go blind. This review summarises some of the clinical features, investigative modalities, and recent therapeutic strategies used in the management of radiation retinopathy.

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“…In particular, post-DEX data included 1-month, 3-month, 6-month, and 12-month follow-up, if available. e risk of bias of randomized studies was evaluated by using the Cochrane Handbook tool [15], while nonrandomized studies were assessed by using the methodological item for nonrandomized studies, as previously reported [16,17].…”

Section: Data Extraction and Quality Assessmentmentioning

confidence: 99%

Intravitreal Dexamethasone Implant for Postoperative Macular Oedema Secondary to Vitrectomy for Epiretinal Membrane and Retinal Detachment: A Systematic Review and Meta-Analysis

Parisi

Fallico

Avitabile

et al. 2021

Journal of Ophthalmology

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Purpose. To evaluate the efficacy of intravitreal dexamethasone implant (DEX) for the treatment of macular oedema secondary to vitrectomy for epiretinal membrane (ERM) and retinal detachment (RD) by conducting a systematic review with meta-analysis of published studies. Methods. Studies reporting clinical outcomes of DEX use for the treatment of macular oedema secondary to ERM and RD vitrectomy were searched on PubMed and Embase databases. The primary outcome was best-corrected visual acuity (BCVA) change between baseline and post-DEX treatment, reported as mean difference (MD) with 95% confidence interval (CI). Mean central macular thickness (CMT) change was assessed as a secondary outcome. Postimplant adverse events, including intraocular pressure rise and cataract development, were reported as well. Results. Five uncontrolled studies, 1 nonrandomized controlled study, and 1 randomized controlled study were included, with a total of 5 cohorts and 3 cohorts in the ERM group and RD group, respectively. Considering the last available follow-up, a significant improvement in postimplant BCVA was found in the overall population, irrespective of the indication for vitrectomy (MD = −0.28, 95% CI = −0.37, −0.20; p < 0.001 ), but with significant heterogeneity. In either group, mean BCVA significantly improved following the implant (in the ERM group, MD = −0.31, 95% CI = −0.40, −0.22; in the RD group, MD = −0.22, 95% CI = −0.41, −0.03), with no difference between the two groups ( p = 0.41 ). However, there was significant heterogeneity in both groups. Considering the last available follow-up, a significant CMT reduction was found in the overall population, irrespective of the indication for vitrectomy (MD = −129.75, 95% CI = −157.49, −102.01; p < 0.001 ). In the ERM group, a significant CMT reduction was shown following DEX (MD = −133.41, 95% CI = −155.37, −111.45; p < 0.001 ), with no heterogeneity. In the RD group, mean CMT reduction was borderline significant (MD = −128.37, 95% CI = −253.57, −3.18; p = 0.040 ), with significant heterogeneity. No difference in CMT improvement was found between the two groups ( p = 0.94 ). Conclusion. This meta-analysis showed that DEX yielded a significant improvement in visual and anatomical outcomes, even if limited by significant heterogeneity. Dexamethasone implant represents an effective treatment for postoperative macular oedema secondary to ERM and RD vitrectomy.

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Treatment of radiation maculopathy and radiation-induced macular edema: A systematic review

Cited by 27 publications

References 61 publications

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Update of the EPTN atlas for CT- and MR-based contouring in Neuro-Oncology

Radiation Retinopathy: Detection and Management Strategies

Intravitreal Dexamethasone Implant for Postoperative Macular Oedema Secondary to Vitrectomy for Epiretinal Membrane and Retinal Detachment: A Systematic Review and Meta-Analysis

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