Treatment of radiation retinopathy following plaque brachytherapy for choroidal melanoma

Wen, Joanne C; McCannel, Tara A.

doi:10.1097/icu.0b013e328329b62d

Cited by 37 publications

(22 citation statements)

References 36 publications

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“…18 Attempts to treat radiation maculopathy have been made using focal laser photocoagulation of leaking macular vessels or nonperfused areas, 19 sector laser photocoagulation to site of radiation, 16,17 oral, subtenon's, or intravitreous corticosteroids, 20,21 and intravitreous injection of antivascular endothelial growth factor. 15,[22][23][24] To some extent, favorable short-term results with mild visual recovery or preservation can be achieved with intravitreous medications, but durable effect has not been proven. Most protocols have depended on ophthalmoscopic evidence of radiation maculopathy or OCT evidence of macular edema.…”

Section: Discussionmentioning

confidence: 97%

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

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Samara

et al. 2016

Retina

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Section: Discussionmentioning

confidence: 97%

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

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Samara

et al. 2016

Retina

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“…The use of hyperbaric oxygen is controversial and may even exacerbate retinopathy (49). Intravitreal triamcinolone therapy and laser photocoagulation may briefly decrease macular edema and achieve modest visual improvements (50). Vitreous hemorrhage and retinal detachment can be managed by vitrectomy and retinal detachment surgery.…”

Section: Prevention and Treatment Of Toxicitymentioning

confidence: 99%

Ocular Risks From Orbital and Periorbital Radiation Therapy: A Critical Review

Jeganathan

Wirth

MacManus

2011

International Journal of Radiation Oncology*Biology*Physics

118

102

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“…13 The result is both retinal exudation (oedema, hard exudates and retinal haemorrhages) and ischaemia (cotton wool spots and capillary dropout). Histologically, there is an obliterative endoarteritis, with loss of vascular endothelial cells and pericytes, capillary closure and thickened vessel walls, leading to neovascularisation.…”

Section: -12mentioning

confidence: 99%

“…9 If ischaemia is present, VEGF likely has a role in the pathogenesis of the retinopathy. 13 It has been hypothesised that bevacizumab may decrease ocular ischaemia resulting from plaque brachytherapy, as well as vascular permeability in non-vital tissue. 14 A few case series have been published regarding the use of bevacizumab (1.25 mg in 0.05 ml) in patients with radiation retinopathy following plaque brachytherapy (see Table 1).…”

Section: -12mentioning

confidence: 99%

Bevacizumab Therapy for Choroidal Melanoma

Lima¹,

Singh²

2012

European Oncology &Amp; Haematology

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Bevacizumab, an anti-angiogenic agent, has gained widespread use in ophthalmology for the treatment of neovascular conditions, such as age-related macular degeneration. Targeting angiogenesis has been proposed as a potential therapy for different kinds of malignancies, by limiting supply of oxygen and nutrients, and consequently tumour growth and metastasis. Bevacizumab has been approved by the US Food and Drug Administration, along with chemotherapy, for the treatment of metastatic colorectal carcinoma and non-small cell lung cancer. Nevertheless, a beneficial effect in the treatment of choroidal melanoma has yet to be demonstrated, despite elevated levels of vascular endothelial growth factor (VEGF). However, bevacizumab might have a role in the management of complications of radiation therapy. KeywordsBevacizumab, choroidal melanoma, optic neuropathy, radiation retinopathy, vascular endothelial growth factor (VEGF) Disclosure: The authors have no conflicts of interest to declare. The impact of intravitreal bevacizumab as a primary therapy for choroidal melanoma and its role in the management of complications (e.g., radiation retinopathy) from established therapies (e.g., brachytherapy) will be discussed here. Results from animal models, in which bevacizumab has been used either systemically or intravitreally, will be reviewed. Current clinical trials looking at the administration of intravitreal or systemic anti-VEGF agents for choroidal melanoma will be summarised. Treatment of Primary TumourIntravitreal bevacizumab, along with other anti-VEGF agents, has gained widespread use in ophthalmology over the last few years for the treatment of neovascular diseases, such as age-related macular degeneration, central retinal vein occlusion, proliferative diabetic retinopathy and macular oedema. It has been shown to reduce neovascular activity and vascular permeability in ocular tissues. It is that of a 55-year-old woman who presented for further investigation of a peripapillary choroidal lesion presumed to be an idiopathic choroidal neovascular membrane, and who was treated with five intravitreal injections of bevacizumab at monthly intervals.Choroidal melanoma has intrinsic vessels and commonly has associated subretinal fluid. Bevacizumab may transiently diminish tumour vasculature and permeability, reducing the subretinal fluid.However, subretinal fluid resolution may be misleading in this scenario and the tumour may to continue to grow. 8In the absence of studies documenting the efficacy of bevacizumab for the treatment of choroidal melanoma, caution is advised in the use of this drug as a sole treatment modality. Management of ComplicationsSince the Collaborative ocular melanoma study (COMS), therapy for medium-sized choroidal melanomas has shifted from enucleation to plaque brachytherapy, as the survival rate has been found to be similar. 7Radiation retinopathy, optic neuropathy, iris neovascularisation and neovascular glaucoma are potential complications of plaque

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Treatment of radiation retinopathy following plaque brachytherapy for choroidal melanoma

Abstract: Currently, there are no proven treatments for radiation retinopathy or maculopathy. The current treatment methods require frequent administration with variable improvement in visual acuity.

Cited by 37 publications

References 36 publications

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

Ocular Risks From Orbital and Periorbital Radiation Therapy: A Critical Review

Bevacizumab Therapy for Choroidal Melanoma

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