Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity

Nisha V. Shah, Samuel K. Houston, Arnold Markoe, William J Feuer, Timothy G. Murray

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Purpose: To evaluate the benefits of intravitreal bevacizumab in patients with visually compromising radiation maculopathy following iodine-125 plaque brachytherapy for uveal melanoma. Methods: In this Institutional Review Board-approved, consecutive, retrospective study from 2006-2009 of patients maintaining 20/50 or better vision following treatment for visually compromising radiation maculopathy, patients were evaluated with spectral domain optical coherence tomography at 2-4 month intervals following plaque removal. Treatment with intravitreal bevacizumab commenced at the first signs of radiation vasculopathy on spectral domain optical coherence tomography with associated decreased best corrected visual acuity, followed by repeat injections for recurrent or persistent vasculopathic changes. Results: At 3 years following plaque brachytherapy, 81 of 159 (50.9%) patients treated for radiation maculopathy demonstrated 20/50 or better vision at median follow up of 36 months, which demonstrates significant improvement in vision as compared to the Collaborative Ocular Melanoma Study (P < 0.0001). These 81 patients were given a mean of five injections (range 1-17) over a mean of 17.6 months (range 1-54 months), starting at 15.8 months (range 3-50 months) after plaque brachytherapy. For those eyes that maintained 20/50 or better vision at the final follow-up, pretreatment mean best corrected visual acuity of 20/43 improved to 20/31. Conclusion: This study demonstrates that spectral domain optical coherence tomography can detect early vasculopathic changes secondary to radiation maculopathy and that prompt treatment with intravitreal bevacizumab may delay vision loss and maintain or possibly improve visual acuity in half of eyes diagnosed with radiation maculopathy. Radiation maculopathy remains a therapeutically manageable morbidity associated with radiation therapy for posterior uveal melanoma.

Original languageEnglish
Pages (from-to)1739-1748
Number of pages10
JournalClinical Ophthalmology
Volume6
Issue number1
DOIs
StatePublished - Oct 26 2012

Fingerprint

Visual Acuity
Radiation
Brachytherapy
Optical Coherence Tomography
Therapeutics
Injections
Research Ethics Committees
Bevacizumab
Iodine
Melanoma
Radiotherapy
Retrospective Studies
Morbidity

Keywords

  • BCVA
  • Intravitreal bevacizumab
  • Plaque brachytherapy
  • Radiation maculopathy
  • Uveal melanoma

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity. / Shah, Nisha V.; Houston, Samuel K.; Markoe, Arnold; Feuer, William J; Murray, Timothy G.

In: Clinical Ophthalmology, Vol. 6, No. 1, 26.10.2012, p. 1739-1748.

Research output: Contribution to journalArticle

Shah, Nisha V. ; Houston, Samuel K. ; Markoe, Arnold ; Feuer, William J ; Murray, Timothy G. / Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity. In: Clinical Ophthalmology. 2012 ; Vol. 6, No. 1. pp. 1739-1748.
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abstract = "Purpose: To evaluate the benefits of intravitreal bevacizumab in patients with visually compromising radiation maculopathy following iodine-125 plaque brachytherapy for uveal melanoma. Methods: In this Institutional Review Board-approved, consecutive, retrospective study from 2006-2009 of patients maintaining 20/50 or better vision following treatment for visually compromising radiation maculopathy, patients were evaluated with spectral domain optical coherence tomography at 2-4 month intervals following plaque removal. Treatment with intravitreal bevacizumab commenced at the first signs of radiation vasculopathy on spectral domain optical coherence tomography with associated decreased best corrected visual acuity, followed by repeat injections for recurrent or persistent vasculopathic changes. Results: At 3 years following plaque brachytherapy, 81 of 159 (50.9{\%}) patients treated for radiation maculopathy demonstrated 20/50 or better vision at median follow up of 36 months, which demonstrates significant improvement in vision as compared to the Collaborative Ocular Melanoma Study (P < 0.0001). These 81 patients were given a mean of five injections (range 1-17) over a mean of 17.6 months (range 1-54 months), starting at 15.8 months (range 3-50 months) after plaque brachytherapy. For those eyes that maintained 20/50 or better vision at the final follow-up, pretreatment mean best corrected visual acuity of 20/43 improved to 20/31. Conclusion: This study demonstrates that spectral domain optical coherence tomography can detect early vasculopathic changes secondary to radiation maculopathy and that prompt treatment with intravitreal bevacizumab may delay vision loss and maintain or possibly improve visual acuity in half of eyes diagnosed with radiation maculopathy. Radiation maculopathy remains a therapeutically manageable morbidity associated with radiation therapy for posterior uveal melanoma.",
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