What is the Role of Radiation in the Treatment of Subfoveal Membranes: Review of Radiobiologic, Pathologic, and Other Considerations to Initiate a Multimodality Discussion

Ten-Year Follow-Up of Eyes Treated With Stereotactic Fractionated External Beam Radiation for Neovascular Age-Related Macular Degeneration

“…4 However, direct damage to the outer retina and RPE by ionizing radiation has been reported in animal and human studies, and radiation-induced choroidal damage has been described. 31–35 In our study population, the size of GA tended to correlate with that of the CNVM rather than that of radiation treatment.…”

“…The two manifestations of visually significant radiation retinopathy observed in our study were neovascular glaucoma (two eyes) and macular ischemia (two eyes), both of which have been reported previously. 4,40 The development of neovascular glaucoma after 40 Gy radiation in 1 patient who was diagnosed with diabetes mellitus after enrollment and treatment is not surprising. However, the development of neovascular glaucoma in another patient with underlying hypertension, after receiving 28 Gy EBR, was concerning.…”

“…Typically, radiation retinopathy is associated with doses>45 Gy 4,25–27 but has been reported after doses as low as 14 Gy given in a single fraction in the treatment of nAMD. 8 Most studies using radiotherapy for nAMD using fractionated radiation of doses <24 Gy have not found evidence of radiation retinopathy, but follow-up for nearly all these studies is ≤2 years.…”

Ten-Year Follow-Up of Eyes Treated With Stereotactic Fractionated External Beam Radiation for Neovascular Age-Related Macular Degeneration

“…4 However, direct damage to the outer retina and RPE by ionizing radiation has been reported in animal and human studies, and radiation-induced choroidal damage has been described. 31–35 In our study population, the size of GA tended to correlate with that of the CNVM rather than that of radiation treatment.…”

“…The two manifestations of visually significant radiation retinopathy observed in our study were neovascular glaucoma (two eyes) and macular ischemia (two eyes), both of which have been reported previously. 4,40 The development of neovascular glaucoma after 40 Gy radiation in 1 patient who was diagnosed with diabetes mellitus after enrollment and treatment is not surprising. However, the development of neovascular glaucoma in another patient with underlying hypertension, after receiving 28 Gy EBR, was concerning.…”

“…Typically, radiation retinopathy is associated with doses>45 Gy 4,25–27 but has been reported after doses as low as 14 Gy given in a single fraction in the treatment of nAMD. 8 Most studies using radiotherapy for nAMD using fractionated radiation of doses <24 Gy have not found evidence of radiation retinopathy, but follow-up for nearly all these studies is ≤2 years.…”

Radiotherapy of exudative age-related macular degeneration; a clinical and pathologic study

“…Radiotherapy affects the evolution of exudative macular degeneration by endothelial toxicity, resulting in narrowing or occlusion of blood vessels [2,9,13]. Endothelial cells are moderately sensitive to irradiation and vessels may reveal manifestations of radiation injury months to years later [1,2,3,23].…”

“…Endothelial cells are moderately sensitive to irradiation and vessels may reveal manifestations of radiation injury months to years later [1,2,3,23]. In CNV, microvessel and endothelial cell loss occurs about a year after irradiation [2]. Moreover, CNV membrane regression is not found until 6 months or more after radiotherapy, independent of the dose administered [10].…”

Ten-Year Follow-Up of Eyes Treated With Stereotactic Fractionated External Beam Radiation for Neovascular Age-Related Macular Degeneration

“…4 However, direct damage to the outer retina and RPE by ionizing radiation has been reported in animal and human studies, and radiation-induced choroidal damage has been described. 31–35 In our study population, the size of GA tended to correlate with that of the CNVM rather than that of radiation treatment.…”

“…The two manifestations of visually significant radiation retinopathy observed in our study were neovascular glaucoma (two eyes) and macular ischemia (two eyes), both of which have been reported previously. 4,40 The development of neovascular glaucoma after 40 Gy radiation in 1 patient who was diagnosed with diabetes mellitus after enrollment and treatment is not surprising. However, the development of neovascular glaucoma in another patient with underlying hypertension, after receiving 28 Gy EBR, was concerning.…”

“…Typically, radiation retinopathy is associated with doses>45 Gy 4,25–27 but has been reported after doses as low as 14 Gy given in a single fraction in the treatment of nAMD. 8 Most studies using radiotherapy for nAMD using fractionated radiation of doses <24 Gy have not found evidence of radiation retinopathy, but follow-up for nearly all these studies is ≤2 years.…”

Radiotherapy of exudative age-related macular degeneration; a clinical and pathologic study

“…Radiotherapy affects the evolution of exudative macular degeneration by endothelial toxicity, resulting in narrowing or occlusion of blood vessels [2,9,13]. Endothelial cells are moderately sensitive to irradiation and vessels may reveal manifestations of radiation injury months to years later [1,2,3,23].…”

“…Endothelial cells are moderately sensitive to irradiation and vessels may reveal manifestations of radiation injury months to years later [1,2,3,23]. In CNV, microvessel and endothelial cell loss occurs about a year after irradiation [2]. Moreover, CNV membrane regression is not found until 6 months or more after radiotherapy, independent of the dose administered [10].…”

Ten-Year Follow-Up of Eyes Treated With Stereotactic Fractionated External Beam Radiation for Neovascular Age-Related Macular Degeneration

“…4 However, direct damage to the outer retina and RPE by ionizing radiation has been reported in animal and human studies, and radiation-induced choroidal damage has been described. 31–35 In our study population, the size of GA tended to correlate with that of the CNVM rather than that of radiation treatment.…”

“…The two manifestations of visually significant radiation retinopathy observed in our study were neovascular glaucoma (two eyes) and macular ischemia (two eyes), both of which have been reported previously. 4,40 The development of neovascular glaucoma after 40 Gy radiation in 1 patient who was diagnosed with diabetes mellitus after enrollment and treatment is not surprising. However, the development of neovascular glaucoma in another patient with underlying hypertension, after receiving 28 Gy EBR, was concerning.…”

“…Typically, radiation retinopathy is associated with doses>45 Gy 4,25–27 but has been reported after doses as low as 14 Gy given in a single fraction in the treatment of nAMD. 8 Most studies using radiotherapy for nAMD using fractionated radiation of doses <24 Gy have not found evidence of radiation retinopathy, but follow-up for nearly all these studies is ≤2 years.…”

Radiotherapy of exudative age-related macular degeneration; a clinical and pathologic study

“…Radiotherapy affects the evolution of exudative macular degeneration by endothelial toxicity, resulting in narrowing or occlusion of blood vessels [2,9,13]. Endothelial cells are moderately sensitive to irradiation and vessels may reveal manifestations of radiation injury months to years later [1,2,3,23].…”

“…Endothelial cells are moderately sensitive to irradiation and vessels may reveal manifestations of radiation injury months to years later [1,2,3,23]. In CNV, microvessel and endothelial cell loss occurs about a year after irradiation [2]. Moreover, CNV membrane regression is not found until 6 months or more after radiotherapy, independent of the dose administered [10].…”