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Perrin EL, Porter RG. INDOCYANINE GREEN ANGIOGRAPHY-GUIDED PHOTOCOAGULATION OF LARGE MICROVASCULAR ABNORMALITIES ("TELCAPS") IN A PATIENT WITH PERSISTENT MACULA EDEMA IN THE CONTEXT OF RADIATION RETINOPATHY. Retin Cases Brief Rep 2024; 18:355-359. [PMID: 36512805 PMCID: PMC11027980 DOI: 10.1097/icb.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this report is to describe a patient with radiation retinopathy who responded to indocyanine green angiography (ICGA)-guided photocoagulation as treatment for persistent macula edema secondary to TelCaps, a newly defined type of large microvascular abnormality. METHODS Retrospective case report. RESULTS A 40-year-old man with a history of bilateral retinoblastoma and right enucleation presented with decreased vision in the left eye secondary to macula edema. Examination revealed radiation retinopathy with a cluster of ICGA-avid large microaneurysms temporal to the macula. The patient did not respond to treatment with intravitreal bevacizumab or triamcinolone. Complete resolution of macula edema was demonstrated after two rounds of ICGA-guided focal photocoagulation to the aforementioned microaneurysm cluster. No subsequent or adjunctive intravitreal injections of anti-VEGF were required, and there was no recurrence of the TelCaps lesions at follow-up to eight years. CONCLUSION TelCaps are large microvascular abnormalities with high affinity for ICG. These lesions may not have been recognized because of difficulties in their detection on routine examination and with investigations including ocular coherence tomography angiogram and fluorescein angiogram. Early evidence supports their role in macula edema that is not responsive to intravitreal injections of anti-VEGF. ICGA-guided photocoagulation of TelCaps lesions can result in resolution of macula edema. To our knowledge, this is the first reported case of TelCaps secondary to radiation retinopathy.
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Affiliation(s)
- Elise L. Perrin
- Metro South Hospital and Health Service, Wynnum West, Australia
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Kubo K, Hashida N, Watanabe A, Maruyama K, Oh RJ, Nishida K. Intensity-Modulated Radiation Therapy for Bilateral Choroidal Metastases Involving Macula and Optic Disc. Cureus 2023; 15:e46729. [PMID: 38022180 PMCID: PMC10631300 DOI: 10.7759/cureus.46729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
This case report discusses the case of a 76-year-old woman with choroidal metastasis from breast cancer who was treated with intensity-modulated radiation therapy (IMRT). Choroidal metastasis is a common ocular tumor, and the occurrence of this condition has increased due to improved diagnostic tools and longer survival of metastatic patients. IMRT is an innovative radiation therapy technique that reduces complications and improves the curative effect by concentrating radiation on the tumor while minimizing exposure to surrounding tissues. In this case, the patient had a history of breast cancer and was undergoing chemotherapy when she presented with vision loss and blurred vision. Imaging tests confirmed choroidal metastasis, and IMRT was performed under the guidance of a radiation oncologist. After treatment, the choroidal lesion dramatically reduced in size, and the patient's vision improved. The text concludes that radiation therapy, including IMRT, is becoming more common as a treatment for ocular metastasis to improve vision and preserve the eye. When choosing radiation therapy, it is essential to consider the size of the tumor and the impact on surrounding tissues. IMRT is an effective treatment that enables precise and concentrated irradiation of the tumor tissue while minimizing exposure to normal tissues.
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Affiliation(s)
- Kenya Kubo
- Department of Ophthalmology, Osaka Rosai Hospital, Sakai, JPN
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JPN
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JPN
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University Graduate School of Medicine, Osaka, JPN
| | - Atsushi Watanabe
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JPN
| | - Kazuichi Maruyama
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JPN
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University Graduate School of Medicine, Osaka, JPN
| | - Ryoong-Jin Oh
- Department of Radiation Oncology, Miyakojima IGRT (Image Guided Radiation Therapy) Clinic, Osaka, JPN
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, JPN
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University Graduate School of Medicine, Osaka, JPN
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Mularska W, Chicheł A, Rospond-Kubiak I. Radiation retinopathy following episcleral brachytherapy for intraocular tumors: Current treatment options. J Contemp Brachytherapy 2023; 15:372-382. [PMID: 38026080 PMCID: PMC10669920 DOI: 10.5114/jcb.2023.132398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
Radiation retinopathy (RR) and radiation maculopathy (RM) can occur as a result of uveal melanoma radiation treatment and after irradiation of other head and neck extraocular tumors, even with precise targeting techniques, such as stereotactic or proton beam radiotherapy. This review provides an overview of the current understanding of potential radiation damage to ocular tissues, and how recent developments in ophthalmic multimodal imaging techniques and treatment modalities have improved managing options. Several treatment strategies have been employed so far for the management of RR, including laser photocoagulation, intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents or glucocorticosteroids and surgery. The use of intravitreal anti-VEGFs or dexamethasone implants have significantly altered the final visual outcome for uveal melanoma patients. As a prophylaxis, a few different strategies were proposed, but still there is a lack of large randomized clinical trials supporting these approaches and clear clinical guidelines for daily practice. Early detection and proper treatment are crucial in preventing or reducing vision loss, and improving patients' quality of life. Close monitoring and timely intervention are essential for successful management.
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Affiliation(s)
- Weronika Mularska
- Department of Ophthalmology, Poznan´ University of Medical Sciences, Poznan´, Poland
| | - Adam Chicheł
- Brachytherapy Department, Greater Poland Cancer Center, Poznan´, Poland
| | - Iwona Rospond-Kubiak
- Department of Ophthalmology, Poznan´ University of Medical Sciences, Poznan´, Poland
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Gaddini L, Bernardo A, Greco A, Campa A, Esposito G, Matteucci A. Adaptive Response in Rat Retinal Cell Cultures Irradiated with γ-rays. Int J Mol Sci 2023; 24:ijms24031972. [PMID: 36768293 PMCID: PMC9916556 DOI: 10.3390/ijms24031972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/16/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Retina can receive incidental γ-ray exposure from various sources. For example, although radiation therapy is a crucial tool for managing head and neck tumors, patients may develop ocular complications as collateral damage from accidental irradiation. Recently, there has been concern that retinal irradiation during space flight may compromise mission goals and long-term quality of life after space travel. Previously, in our in vitro model, we proved that immature retinal cells are more vulnerable to γ-radiation than differentiated neurons. Here, we investigate if a low-dose pre-irradiation (0.025 Gy), known to have a protective effect in various contexts, can affect DNA damage and oxidative stress in cells exposed to a high dose of γ-rays (2 Gy). Our results reveal that pre-irradiation reduces 2 Gy effects in apoptotic cell number, H2AX phosphorylation and oxidative stress. These defensive effects are also evident in glial cells (reduction in GFAP and ED1 levels) and antioxidant enzymes (catalase and CuZnSOD). Overall, our results confirm that rat retinal cultures can be an exciting tool to study γ-irradiation toxic effects on retinal tissue and speculate that low irradiation may enhance the skill of retinal cells to reduce damage induced by higher doses.
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Affiliation(s)
- Lucia Gaddini
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy
- Correspondence:
| | - Antonietta Bernardo
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Anita Greco
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Alessandro Campa
- National Centre for Radiation Protecti on and Computational Physics, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Giuseppe Esposito
- National Center for Innovative Technologies in Public Health, Istituto Superiore di Sanità, 00161 Rome, Italy
- Istituto Nazionale di Fisica Nucleare (INFN), Sezione Roma 1, 00185 Rome, Italy
| | - Andrea Matteucci
- National Center for Drug Research and Evaluation, Istituto Superiore di Sanità, 00161 Rome, Italy
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Sabaner MC, Dogan M. Treatment of Intravitreal Ranibizumab Resistant Radiation Retinopathy with Intravitreal Dexamethasone Implant: A Case Report. Beyoglu Eye J 2022; 7:324-8. [PMID: 36628082 DOI: 10.14744/bej.2022.72602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/12/2022] [Accepted: 06/23/2022] [Indexed: 01/13/2023]
Abstract
A 43-year-old female patient presented with complaints of decreased vision in both eyes. Her medical history revealed the diagnosis of metastatic breast cancer. She was treated with chemotherapy, and whole-brain, manubrium sterni, and right chest wall radiation therapy. Best-corrected visual acuity (BCVA) was 20/200 and 20/160 in the right and left eye, respectively. Optical coherence tomography (OCT) confirmed the presence of cystoid macular edema (CME). OCT angiography confirmed the presence of microaneurysms, ischemia, and capillary drop-out on the macula. Fundus fluorescein angiography revealed multiple microaneurysms with surrounding ischemia and leakage. Based on these findings and medical history, a diagnosis of radiation maculopathy was considered. The patient was administered intravitreal four doses of ranibizumab injections. Laser photocoagulation was performed on the ischemic areas of the retina in both eyes. Despite the follow-up and treatment, the presence of residual CME and BCVA 20/200 in both eyes was determined; it was decided to change the treatment regimen to an intravitreal dexamethasone implant. One month after injection, BCVA was 20/80 in both eyes, and normal foveal contour and no edema as confirmed on OCT. The DEX implant showed a promising result and should be kept in mind in the treatment of radiation retinopathy.
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Cicinelli MV, Di Nicola M, Gigliotti CR, Battista M, Miserocchi E, Vecchio A, Mortini P, Bandello F, Modorati GM. Predictive factors of radio-induced complications in 194 eyes undergoing gamma knife radiosurgery for uveal melanoma. Acta Ophthalmol 2021; 99:e1458-e1466. [PMID: 33638277 DOI: 10.1111/aos.14814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/03/2021] [Accepted: 02/02/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE To report the factors predictive of radio-induced complications (i.e. radiation retinopathy [RR], radiation papillopathy [RP] and neovascular glaucoma [NVG]) in uveal melanoma (UM) patients undergoing gamma knife radiosurgery (GKR). MATERIALS AND METHODS Longitudinal cohort study on patients with UM treated at the Ocular Oncology Service, San Raffaele Scientific Institute, Milan, between June 1994 and November 2018. Data were retrospectively reviewed. Rates of GKR-related complications were reported. Variables associated with each complication were investigated using multivariable Cox models and confirmed by logistic regression analysis. Hazard ratio (HR) and 95% confidence intervals (CI) were reported for significant associations. RESULTS One hundred ninety-four patients (99 males, 51%) were included, and 184 tumours were primarily located in the choroid (95%). Median follow-up was 57 months (range 6-286). Local control was achieved in 182 eyes (94%), and 152 eyes (78%) experienced at least one radiation-induced complication. Radiation retinopathy was documented in 67 eyes (35%) after a median of 23 months. Older age (HR = 0.97, 95% CI = 0.95-0.99, p = 0.02) had a protective effect for RR. Radiation papillopathy was diagnosed in 35 eyes (18%) after a median of 14 months after GKR. Macular or peripapillary location (HR = 3.06, 95% CI = 1.52-6.16, p = 0.002) was associated with increased risk of RP, while older age was protective (HR = 0.95, 95% CI = 0.93-0.98, p = 0.001). New-onset NVG was found in 53 eyes (27%), and median onset was 28 months. Tumour thickness (HR = 4.41, 95% CI = 2.23-8.72, p < 0.001) and peripapillary location (HR = 2.78, 95% CI = 1.46-5.27, p = 0.002) were the main risk factors associated with NVG. CONCLUSION Understanding factors predictive for radiation-related complications in patients undergoing GKR might help for better counselling and treatment planning.
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Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | - Maura Di Nicola
- Ocular Oncology Service University of Cincinnati College of Medicine Cincinnati OH USA
| | | | - Marco Battista
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
| | | | - Antonella Vecchio
- Department of Medical Physics IRCCS San Raffaele Scientific Institute Milan Italy
| | - Pietro Mortini
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Neurosurgery and Gamma Knife Radiosurgery IRCCS San Raffaele Scientific Institute Milan Italy
| | - Francesco Bandello
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
- Department of Ophthalmology IRCCS San Raffaele Scientific Institute Milan Italy
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Sahoo NK, Ranjan R, Tyagi M, Agrawal H, Reddy S. Radiation Retinopathy: Detection and Management Strategies. Clin Ophthalmol 2021; 15:3797-3809. [PMID: 34526764 PMCID: PMC8436254 DOI: 10.2147/opth.s219268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022] Open
Abstract
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 post-treatment 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, anti-vascular 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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Affiliation(s)
- Niroj Kumar Sahoo
- Department of Retina and Vitreous, L V Prasad Eye Institute, Vijayawada, India
| | - Richa Ranjan
- Bharti Eye Foundation and Hospital, New Delhi, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Hitesh Agrawal
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Subhakar Reddy
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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Hage R, Alapetite C, Brisse H, Zuber K, Lecler A, Lot G, Le Guerinel C, Vignal-Clermont C, Boissonnet H. Efficacy and Safety of Proton Beam Therapy for Primary Optic Nerve Sheath Meningioma. Eye Brain 2021; 13:219-229. [PMID: 34466049 PMCID: PMC8402992 DOI: 10.2147/eb.s305822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/30/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Management of optic nerve sheath meningiomas (ONSM) remains challenging. Photon radiation therapy (PhRT) is the most common treatment for sight-threatening ONSM. Proton beam therapy (PBT) is less commonly used because it is more expensive and because there are questions about its efficacy specifically in relation to ONSM. PBT has the theoretical advantage of reducing radiation exposure to adjacent structures. We report the visual outcome of patients with primary ONSM managed at the Fondation Ophtalmologique Adolphe de Rothschild, Paris, France, and treated with PBT at the Centre de Protonthérapie, Institut Curie, Orsay, France. Methods We conducted a retrospective review of all patients with primary ONSM who received PBT (either by itself or following surgery) between January 2006 and January 2019. Neuro-ophthalmic examinations were performed at presentation and after radiotherapy, and, when applicable, after surgery. Meningiomas were measured at the time of diagnosis and at each follow-up MRI examination. Results Sixty patients (50 women, 10 men; mean age, 45.2±11.1y) were included, of whom 29 underwent surgery. At presentation, 52 (87%) of them had decreased vision (average visual acuity: 0.6 logMAR). Fundus examination showed optic disc swelling (n=27; 46.5%), optic disc pallor (n=22; 37.9%), optic disc cupping (n=2; 3.4%), opto-ciliary shunt (n=8; 13.8%), or choroidal folds (n=5; 8.6%). Otherwise, it was unremarkable (n=7; 12.1%). After treatment, visual function was stable overall. Fundus examination showed pallor (n=47; 83.9%), swelling (n=3; 5.4%), or cupping (n=2; 3.4%) of the optic disc, or was unremarkable (n=5; 8.9%). The visual field of 8 patients worsened, while 3 developed asymptomatic retinal hemorrhages. Tumor shrunk significantly in 8 patients at 1 year after PBT and remained stable in size in all others. Patients with opto-ciliary shunts had significantly worse visual outcome than other patients. Retinal abnormalities were observed in 11 patients during follow-up. Conclusion PBT alone or in association with surgery appears to be a safe and efficient treatment for ONSM, reducing the tumor size and stabilizing visual function. The risk of developing radiation retinopathy seems to be higher when patients had upfront surgery.
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Affiliation(s)
- Rabih Hage
- Neuro-ophthalmology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Claire Alapetite
- Radiation Oncology Department, and Proton Center Institut Curie, Paris-Orsay, France
| | - Hervé Brisse
- Imaging Department, Institut Curie, Paris, France.,Université des Sciences et Lettres, Paris, France
| | - Kevin Zuber
- Department of Statistics and Clinical Research, Hôpital Fondation A. de Rothschild, Paris, France
| | - Augustin Lecler
- Radiology Department, Hôpital Fondation A. de Rothschild, Paris, France
| | - Guillaume Lot
- Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, France
| | | | | | - Herve Boissonnet
- Neurosurgery Department, Hôpital Fondation A. de Rothschild, Paris, France
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Li Z, Zhan Z, Xiao J, Lan Y. Radiation-Induced Optical Coherence Tomography Angiography Retinal Alterations in Patients With Nasopharyngeal Carcinoma. Front Med (Lausanne) 2021; 7:630880. [PMID: 33614678 PMCID: PMC7886685 DOI: 10.3389/fmed.2020.630880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/23/2020] [Indexed: 11/13/2022] Open
Abstract
Aim: The aim of the study was to investigate the early neurovascular alterations of the retina in radiation encephalopathy (RE) patients with normal-ranged visual acuity after radiotherapy for nasopharyngeal carcinoma. Methods: Fifty-five RE patients and 54 healthy age-matched subjects were enrolled in this retrospective cross-sectional case–control study. The best corrected visual acuity (LogMAR) of the included eye should not be more than 0. The vessel density and thickness of different locations in the retina were acquired automatically using optical coherence tomography angiography (OCTA). The data were then compared between the RE patients and the controls. The location included the whole retina, the superficial vascular plexus (SVP)/the ganglion cell complex (GCC), the deep vascular plexus (DVP), and the choroid in the macular area, as well as the inside disc and peripapillary area in the optic nerve head (ONH). The risk factors in OCTA retinal impairments were analyzed using a backward multiple linear regression. The relationships between mean deviation (MD) and pattern standard deviation (PSD) in the visual field (VF) and the OCTA parameters were also analyzed in RE patients. Results: The vessel density of the GCC was significantly reduced in RE patients compared with controls (p = 0.018), and the reductions were mainly shown in the parafoveal (p = 0.049) and perifoveal fields (p = 0.006). The thickness of the GCC was correspondingly reduced (whole image GCC mean thickness: p = 0.044; parafoveal thickness: p = 0.038; perifoveal thickness: p = 0.038). In addition, the sub-foveal choroidal thickness (p = 0.039) was also reduced in RE patients. The vessel density of the GCC (R2 = 0.643) and DVP (R2 = 0.777) had a significant positive correlation with high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1) and had a significant negative correlation with age (GCC: HDL-C, β = 29.89, p = 0.005; ApoA1, β = 78.92, p = 0.002; age, β = −0.886, p = 0.001; DVP: HDL-C, β = 40.09, p = 0.003; ApoA1, β = 62.65, p = 0.013; age, β = −1.31, p = 0.001). The vessel density of the GCC also had a significant negative correlation with apolipoprotein B (ApoB) (β = −32.18, p = 0.006). In the VF, MD had a significant positive correlation with the vessel density inside disc (R2 = 0.241, β = 0.304, p = 0.045), whereas PSD showed a significant negative correlation with the vessel density inside disc and the average GCC thickness, respectively (R2 = 0.437; vessel density inside disc, β = −0.358, p = 0.004; average GCC thickness, β = −0.510, p < 0.001). Conclusion: With the aid of OCTA, we found that neurovascular alterations of the retina may exist in RE patients with normal-ranged visual acuity. Herein, we suggest the implementation of OCTA to assist ophthalmologists in the early detection and consistent monitoring of radiation-related eye diseases to avoid delayed diagnosis.
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Affiliation(s)
- Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zongyi Zhan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianhui Xiao
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuqing Lan
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Midena G, Parrozzani R, Frizziero L, Midena E. Chorioretinal Side Effects of Therapeutic Ocular Irradiation: A Multimodal Imaging Approach. J Clin Med 2020; 9:E3496. [PMID: 33138120 DOI: 10.3390/jcm9113496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/18/2022] Open
Abstract
Radiation chorioretinopathy, radiation maculopathy, and radiation optic neuropathy are the major complications of ophthalmic radiotherapy. Optical coherence tomography (OCT) and OCT angiography (OCTA) are revolutionary imaging methods, allowing the visualization of the retinal cellular architecture and the retinal vascular system, respectively. In recent years this multimodal imaging approach has been applied to several retinal disease, but its role in the clinical characterization of retinal complications secondary to ophthalmic radiotherapy has not yet been defined. The purpose of this review is to critically evaluate the role of OCT and OCTA in the clinical assessment of radiation-induced chorioretinopathy, maculopathy, and optic neuropathy.
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Fallico M, Chronopoulos A, Schutz JS, Reibaldi M. Treatment of radiation maculopathy and radiation-induced macular edema: A systematic review. Surv Ophthalmol 2020; 66:441-460. [PMID: 32918934 DOI: 10.1016/j.survophthal.2020.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
Radiation maculopathy and radiation-induced macular edema are common, sight-threatening complications after radiotherapy, especially that used for uveal melanoma. While many treatment and preventive strategies have been proposed, management of these conditions is still challenging. Initially, treatments were based on the use of retinal laser, but the outcomes were poor. Subsequently, management has shifted toward injection of intravitreal antivascular endothelial growth factor or corticosteroids. We reviewed current clinical evidence, which mostly relies on small sample-sized and retrospective studies, for the management of radiation maculopathy and, in particular, radiation-induced macular edema. At present, the first-line approach is usually intravitreal antivascular endothelial growth factor. Intravitreal dexamethasone implantation may be an option for those with suboptimal response or contraindications to antivascular endothelial growth factor agents. Possible preventive treatments that require future study are intravitreal bevacizumab and ranibizumab, peripheral laser photocoagulation, and subtenon triamcinolone acetonide.
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Affiliation(s)
- Matteo Fallico
- Department of Ophthalmology, University of Catania, Catania, Italy.
| | - Argyrios Chronopoulos
- Department of Ophthalmology, Hospital of Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - James S Schutz
- Department of Ophthalmology, University Hospitals and School of Medicine, Geneva, Switzerland
| | - Michele Reibaldi
- Department of Surgical Sciences, Eye Clinic Section, University of Turin, Turin, Italy
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Özcan G, Gündüz AK, Mirzayev İ, Oysul K, Uysal H. Early Results of Stereotactic Radiosurgery in Uveal Melanoma and Risk Factors for Radiation Retinopathy. Turk J Ophthalmol 2020; 50:156-162. [PMID: 32631003 PMCID: PMC7338750 DOI: 10.4274/tjo.galenos.2019.78370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To report treatment results and complications of stereotactic radiosurgery in uveal malignant melanoma and to identify risk factors for development of radiation retinopathy. Materials and Methods: This was a retrospective study of 36 patients diagnosed with uveal melanoma between 2014 and 2019. Best corrected visual acuity, funduscopic findings, basal tumor diameter and tumor thickness were recorded at baseline and at follow-up visits at 3-month intervals. The response of tumors to stereotactic radiosurgery and complications were determined. Results: The mean basal diameter of tumor was 10.2 (range: 4.0-19.4, standard deviation [SD]: ±3.3) mm x 9.7 (range: 4.5-18.0, SD: ±3.3), tumor thickness was 5.1 (range: 2.0-11.0, ±2.4) mm at baseline. The mean follow-up period was 17.2 (range: 6-48, SD: ±10.43) months. The mean visual acuity was 0.5 (SD: ±0.3) logMAR before treatment and 0.6 (SD: ±0.3) logMAR after the mean follow-up period. The most common complications after stereotactic radiosurgery were cataract (38.9%) and radiation retinopathy (27.7%). There was a statistically significant relation between radiation retinopathy development and tumor distance from the optic disc (p=0.04). The rate of eye salvage was 83.3% in this study. Conclusion: Our short-term results show stereotactic radiosurgery was an effective and sustained treatment modality among the other eye conservation therapies.
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Affiliation(s)
- Gökçen Özcan
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İbadulla Mirzayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Kaan Oysul
- Medicana International Hospital, Clinic of Radiation Oncology, Ankara, Turkey
| | - Hasan Uysal
- Medicana International Hospital, Clinic of Radiation Oncology, Ankara, Turkey
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Chang M, Dalvin LA, Mazloumi M, Martin A, Yaghy A, Yang X, Bakhtiari S, Li L, Jennings E, Mashayekhi A, Shields CL. Prophylactic Intravitreal Bevacizumab After Plaque Radiotherapy for Uveal Melanoma: Analysis of Visual Acuity, Tumor Response, and Radiation Complications in 1131 Eyes Based on Patient Age. Asia Pac J Ophthalmol (Phila) 2020; 9:29-38. [PMID: 31990743 PMCID: PMC7004475 DOI: 10.1097/apo.0000000000000271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to determine the impact of age on radiation complications after plaque radiotherapy and prophylactic intravitreal bevacizumab for uveal melanoma. DESIGN Retrospective cohort study. METHODS Retrospective single-center study of plaque-irradiated uveal melanoma with prophylactic intravitreal bevacizumab at 4-month intervals from July 2000 to January 2018. RESULTS Of 1131 eyes in 1131 patients, age was <50 years (n = 231), 50 to 70 years (n = 657), or >70 years (n = 243). Comparison by age category (<50 vs 50-70 vs >70 years) revealed the oldest group presenting with greatest tumor basal diameter (11.3 vs 11.3 vs 12.1 mm, P = 0.03) and worst visual acuity (20/40 vs 20/40 vs 20/50, P = 0.02). After plaque (mean follow-up 40 vs 42 vs 32 months, P < 0.001), radiation complications were most common in the youngest age group, including maculopathy (48% vs 39% vs 28%, P < 0.001), extramacular retinopathy (30% vs 25% vs 16%, P = 0.002), and papillopathy (21% vs 18% vs 12%, P = 0.03). The youngest age group had the highest Kaplan-Meier estimated 48-month cumulative probability for radiation maculopathy (62% vs 46% vs 47%, P = 0.001), extramacular retinopathy (36% vs 34% vs 29%, P = 0.03), and papillopathy (29% vs 26% vs 22%, P = 0.13). On subanalysis, the youngest age group had increased 48-month risk of developing radiation maculopathy when compared with the middle [hazard ratio (HR) = 1.5, P = 0.001] and older (HR = 1.6, P = 0.005) age groups and increased 48-month risk of developing extramacular radiation retinopathy compared with the older age group (HR = 1.5, P = 0.04). CONCLUSIONS After plaque radiotherapy for uveal melanoma and prophylactic intravitreal bevacizumab at 4-month intervals, patients younger than 50 years old have an increased 48-month risk of radiation maculopathy.
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Affiliation(s)
- Michael Chang
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Lauren A. Dalvin
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Mehdi Mazloumi
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Andrei Martin
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Antonio Yaghy
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Xiaolu Yang
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Saba Bakhtiari
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Lucy Li
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Erin Jennings
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Arman Mashayekhi
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
| | - Carol L. Shields
- From the Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, 840 Walnut Street, 14th Floor, Philadelphia, PA
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Abstract
Innovations in ophthalmic imaging have made a profound impact on the diagnosis and treatment of ophthalmic disease. In ocular oncology, the development of optical coherence tomography with enhanced depth imaging and swept source technologies has made it possible to visualize the anatomical characteristics of retinoblastoma and uveal melanoma with a level of detail previously unobtainable on clinical exam alone. As a result, our understanding of the pathophysiology of vision loss in choroidal melanoma in particular has improved. These modalities have also helped identify fundoscopically “invisible” tumors and risk stratify pre-malignant choroidal lesions, making a strong case for their inclusion in all screening evaluations. Optical coherence tomography angiography, on the other hand, has allowed non-invasive imaging of the retinal and uveal vasculatures, providing insight into vascular changes associated with malignant transformation and vision loss following exposure to radiation. While the impact of new imaging technologies on clinical outcomes and overall survival in ocular oncology has yet to be determined, several reports cited herein offer promising results.
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Affiliation(s)
- Jose R Davila
- Ophthalmology, Stanford Byers Eye Institute, Palo Alto, CA, 94303, USA
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Karagiannis D, Kontomichos L, Georgalas I, Peponis V, Antoniou E, Parikakis E. Glioma-associated radiation retinopathy treated successfully with aflibercept. Ther Clin Risk Manag 2019; 15:937-941. [PMID: 31440056 PMCID: PMC6669310 DOI: 10.2147/tcrm.s204841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/08/2019] [Indexed: 11/24/2022] Open
Abstract
Radiation retinopathy is a chronic, progressive retinal microangiopathy which can occur with variable latency after retina exposure to ionizing radiation used for cancer treatment. It can occur secondary to treatment of nasopharyngeal tumors, as well as intraocular tumors, such as uveal melanoma and retinoblastoma. Several treatment modalities have been reported including intravitreal corticosteroids, intravitreal anti-VEGFs and argon laser photocoagulation. Our purpose is to present a case report of bilateral radiation retinopathy with macular edema in one eye that was revealed 6 years after glioma therapy and treated successfully by using monotherapy of aflibercept. A 59-year-old male patient presented with gradually deteriorating visual acuity in his left eye for the past 12 months. Best corrected visual acuity in his right eye was 20/25 and in his left eye 20/100. Fundoscopy and fluorescein angiography revealed severe non-proliferative retinopathy in his right eye and proliferative retinopathy in his left eye with macular edema. Following complete work-up and due to his past medical history, he was diagnosed with radiation retinopathy. The patient received 6 intravitreal injections of aflibercept in a period of 9 months in order to treat macular edema and radiation retinopathy. According to the literature, there is minimal experience using aflibercept monotherapy to successfully treat macular edema due to radiation retinopathy. In addition, radiotherapy for glioma is a rather rare cause of radiation retinopathy compared to other more common causes, such as nasopharyngeal tumors, meningiomas, and uveal melanomas.
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Affiliation(s)
- D Karagiannis
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - L Kontomichos
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
| | - I Georgalas
- First Department of Ophthalmology, National and Kapodistrian University of Athens, Athens, Greece
| | - V Peponis
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
| | | | - E Parikakis
- Second Department of Ophthalmology, Opthalmiatreion Eye Hospital of Athens, Athens, Greece
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Abstract
Purpose Silicone oil a burgeoning adjuvant in the treatment of uveal melanoma where it is used for tissue protection during I-125 brachytherapy. While risk factors in the development of radiation retinopathy (RR) have been identified, treatment modulation for high-risk patients has largely been overlooked. We seek to expand the literature on this subject by reporting outcomes of I-125 brachytherapy with silicone oil in a high-risk population in the community setting. Methods Five patients with uveal melanoma and at least one risk factor for RR development underwent iodine-125 (I-125) plaque brachytherapy with concurrent pars plana vitrectomy (PPV), silicone oil administration, and fine needle aspiration biopsy (FNAB). Plaque and silicone oil removal were performed after seven days. Minimum follow-up was 12 months. Results Follow-up ranged from 12 to 56 months. Macular radiation doses ranged from 12.55 to 141.5 Gy; the two eyes with the largest doses developed RR at 34 and 15 months as well as neovascular glaucoma (NVG). Surgical complications included one rhegmatogenous retinal detachment (RD) and an intra-operative vitreous hemorrhage with post-operative hyphema requiring additional intervention. Conclusion RR may be attenuated by silicone oil administration in patients with some risk factors. In tumors farther from the macula, this benefit is more readily apparent. Tumors located more posteriorly may not benefit from silicone oil administration considering postoperative complications and operating time. Patient demographics, tumor characteristics, and anticipated macular radiation dosage may help determine which patients can benefit from silicone oil and identify patient risks for adverse outcomes.
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Affiliation(s)
- Lance J Lyons
- Ophthalmology, University of Texas Medical Branch, Galveston, USA
| | - Ethan D Hinds
- Ophthalmology, University of Texas Medical Branch, Galveston, USA
| | - Sarada Chexal
- Ophthalmology, Retina Consultants of Austin, Austin, USA
| | - Brian Berger
- Ophthalmology, Retina Consultants of Austin, Austin, USA
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Rose K, Krema H, Durairaj P, Dangboon W, Chavez Y, Kulasekara SI, Hudson C. Retinal perfusion changes in radiation retinopathy. Acta Ophthalmol 2018; 96:e727-e731. [PMID: 29998553 DOI: 10.1111/aos.13797] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/24/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE To investigate retinal blood flow and oxygen saturation changes in patients diagnosed with retinopathy following plaque radiation treatment to treat choroidal melanoma. METHODS Eight patients (mean age 55.75 years, SD 12.58 years) who have developed unilateral ischaemic radiation-related retinopathy as confirmed by wide-field fluorescein angiography were recruited for the study. The fellow eye with no other ocular or retinal pathology was used as control. Both eyes underwent measurement of total retinal blood flow (TRBF) and retinal blood oxygen saturation using prototype methodologies of Doppler Spectral Domain Optical Coherence Tomography (OCT) and Hyperspectral Retinal Camera, respectively. RESULTS The average TRBF in the retinopathy eye was significantly lower compared to the fellow eye (33.48 ± 12.73 μl/min versus 50.37 ± 15.26 μl/min; p = 0.013). The arteriolar oxygen saturation (SaO2 ) and venular oxygen saturation (SvO2 ) were higher in the retinopathy eye compared to the fellow eye (101.11 ± 4.26%, versus 94.45 ± 5.79%; p = 0.008) and (62.96 ± 11.05% versus 51.24 ± 6.88%, p = 0.051), respectively. CONCLUSION The ionizing radiation seems to have an impact on the TRBF, SaO2 and SvO2 , clinically presenting similar to a rapidly developing diabetic retinopathy. The results show an altered retinal vascular physiology in patients with radiation-related retinopathy.
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Affiliation(s)
- Kalpana Rose
- School of Optometry and Vision Science; University of Waterloo; Waterloo Ontario Canada
- Department of Ophthalmology and Vision Sciences; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
| | - Hatem Krema
- Department of Ophthalmology and Vision Sciences; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
- Ocular Oncology Service; Princess Margaret Cancer Centre/University Health Network; Toronto Ontario Canada
| | - Priya Durairaj
- Ocular Oncology Service; Princess Margaret Cancer Centre/University Health Network; Toronto Ontario Canada
| | - Wantanee Dangboon
- Ocular Oncology Service; Princess Margaret Cancer Centre/University Health Network; Toronto Ontario Canada
| | - Yael Chavez
- Ocular Oncology Service; Princess Margaret Cancer Centre/University Health Network; Toronto Ontario Canada
| | - Susith I. Kulasekara
- Department of Ophthalmology; Royal Darwin Hospital; Darwin Northern Territory Australia
| | - Christopher Hudson
- School of Optometry and Vision Science; University of Waterloo; Waterloo Ontario Canada
- Department of Ophthalmology and Vision Sciences; Toronto Western Hospital; University of Toronto; Toronto Ontario Canada
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18
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Zemba M, Malciolu RA. Choroidal melanoma suspect. Conservative treatment and evolution. Case report. Rom J Ophthalmol 2016; 60:264-269. [PMID: 29450360 PMCID: PMC5711292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2016] [Indexed: 06/08/2023] Open
Abstract
We present the case of a 42-year-old female who presented to our clinic for phosphenes in the left eye, occurring along with eye movement. A diagnosis of choroidal melanoma suspect was made. Due to the patient's profile, young, active woman, surgeon, and the limited therapeutic options in Romania, a conservative treatment and brachytherapy were chosen, which were successfully performed abroad. The patient has been followed-up, so far, for five years after the procedure, with spectacular results.
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Affiliation(s)
- Mihail Zemba
- Department of Ophthalmology, “Dr. Carol Davila” Central Military
University Emergency Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Radu Alexandru Malciolu
- Department of Ophthalmology, “Dr. Carol Davila” Central Military
University Emergency Hospital, Bucharest, Romania
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Zahir F, Tahri H. [ Radiation retinopathy]. Pan Afr Med J 2015; 22:54. [PMID: 26664555 PMCID: PMC4662512 DOI: 10.11604/pamj.2015.22.54.6395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/02/2015] [Indexed: 11/16/2022] Open
Affiliation(s)
- Fadoua Zahir
- Service d'Ophtalmologie, CHU Hassan II, Fès, Maroc
| | - Hicham Tahri
- Service d'Ophtalmologie, CHU Hassan II, Fès, Maroc
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Gündüz K, Kurt RA, Erden E. Ectopic orbital meningioma: report of two cases and literature review. Surv Ophthalmol 2014; 59:643-8. [PMID: 25444364 DOI: 10.1016/j.survophthal.2014.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 01/23/2014] [Accepted: 01/28/2014] [Indexed: 11/22/2022]
Abstract
Ectopic orbital meningioma is a rare tumor usually affecting the medial orbit. We present two cases that occurred in a 56-year-old woman and a 28-year-old man. The tumors in both patients were subtotally excised via orbitotomy surgery and were located in the superior quadrant in one of our patients and in the temporal quadrant in the other. Following histopathologic diagnosis, external beam radiotherapy (EBRT) was administered to one patient and intensity modulated radiotherapy to the other. We identified 12 other well-documented cases of ectopic orbital meningioma previously reported. Ectopic meningioma should be considered in the differential diagnosis of medial as well as lateral and superior orbital tumors. The tumor is usually well circumscribed but can be ill defined in imaging studies. There are intralesional calcifications and sclerosis of adjacent bone in some cases. Ectopic orbital meningioma can recur after incomplete excision. Based on the efficacy of EBRT in optic nerve sheath meningioma, we used this treatment to decrease the risk of recurrence in our two patients and found no tumor recurrence at follow-ups of 24 and 74 months, but one patient had severe vision loss from radiation retinopathy.
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Loukianou E, Brouzas D, Georgopoulou E, Koutsandrea C, Apostolopoulos M. Intravitreal bevacizumab for macular edema due to proton beam radiotherapy: Favorable results shown after eighteen months follow-up. Ther Clin Risk Manag 2010; 6:249-52. [PMID: 20526443 PMCID: PMC2878959 DOI: 10.2147/tcrm.s7051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of intravitreal injections of bevacizumab (Avastin((R))) as a treatment option for radiation maculopathy secondary to proton beam radiotherapy for choroidal melanoma. CASE A 61-year-old woman presented with a gradual decrease in left eye visual acuity (VA) 29 months after proton beam radiotherapy for choroidal melanoma. On presentation, her best-corrected VA (BCVA) was 2/10 in the left eye and the intraocular pressure was 15 mmHg. Fundoscopy revealed cystoid macular edema, intraretinal hemorrhages, epiretinal membrane in the posterior pole, and residual tumor scar with exudative retinal detachment and hard exudates in the periphery of the superotemporal quadrant. A treatment with intravitreal injections of bevacizumab (Avastin((R))) was recommended. The injections were performed on a six-weekly basis. RESULTS The central retinal thickness prior to the treatment was 458 mum. After the first intravitreal injection of bevacizumab, the retinal thickness at the centre of the fovea was reduced to 322 mum. After the third injection, the central retinal thickness was 359 mum and 18 months after presentation, it reduced to 334 mum. The BCVA increased to 3/10 after the intravitreal injections of bevacizumab and remained stable during the follow-up period. The intraocular pressure was within normal range during the follow-up period. CONCLUSION Bevacizumab should be regarded as a treatment option for macular edema due to proton beam radiotherapy for choroidal melanoma. By reducing the central retinal thickness, intravitreal bevacizumab can improve VA or ameliorate further decline caused by radiation maculopathy.
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