Long-term Visual Acuity Results of Treated and Untreated Radiation Retinopathy (an AOS Thesis)

Overview

Journal Trans Am Ophthalmol Soc

Specialty Ophthalmology

Date 2009 Mar 12

PMID 19277244

Citations 17

Authors

James L Kinyoun

Affiliations

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Abstract

Purpose: To report ocular findings in eyes with radiation retinopathy and visual acuity (VA) results of photocoagulation for macular edema and proliferative retinopathy.

Methods: This retrospective case series compared VA after photocoagulation treatment and nontreatment of radiation macular edema. Visual outcomes were assessed with regression analyses.

Results: Eighty-seven eyes (78 [89.7%] treated with external beam irradiation and 9 treated with local plaques) were studied. Fifty-nine (67.8%) and 28 (32.2%) eyes had nonproliferative and proliferative retinopathy, respectively; macular edema developed in 42 nonproliferative eyes (71.2%) and 24 proliferative eyes (85.7%). Initial VAs (median) were 20/40 and 20/65 for nonproliferative and proliferative eyes, respectively, and final VA was 20/80 and 20/400. Initial VA (median) in eyes with macular edema was 20/50 compared to 20/25 in eyes without edema; final VAs were 20/200 and 20/30. Comparing treated (19 [45.2%]) and untreated (23[54.8%]) macular edema in 42 eyes with nonproliferative retinopathy, initial median VA (20/40 and 20/50) and final VA (20/100 and 20/200) were better in treated eyes. Regression analysis showed significant treatment effect (P = .003) when initial VA (logMAR) and months of follow-up were kept constant; treated eyes had mean final VA (logMAR) 0.36 (95% CI, 0.12-0.60) better than untreated eyes.

Conclusions: The presence of macular edema and proliferation indicates more severe retinopathy and worse visual prognosis than for eyes without macular edema and proliferation. Although these VA results suggest macular photocoagulation is beneficial, eyes with macular edema continue to lose vision despite treatment. Better prevention and treatment methods are needed for radiation retinopathy.

Citing Articles

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Tamplin M, Deng W, Garvin M, Binkley E, Hyer D, Buatti J Invest Ophthalmol Vis Sci. 2021; 62(1):3.

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References

Fryczkowski A, Hodes B, Walker J . Diabetic choroidal and iris vasculature scanning electron microscopy findings. Int Ophthalmol. 1989; 13(4):269-79. DOI: 10.1007/BF02280087. View

Parsons J, Bova F, Fitzgerald C, Mendenhall W, Million R . Radiation retinopathy after external-beam irradiation: analysis of time-dose factors. Int J Radiat Oncol Biol Phys. 1994; 30(4):765-73. DOI: 10.1016/0360-3016(94)90347-6. View

. The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: V. Twelve-year mortality rates and prognostic factors: COMS report No. 28. Arch Ophthalmol. 2006; 124(12):1684-93. DOI: 10.1001/archopht.124.12.1684. View

Khawly J, Rubin P, Petros W, Peters W, Jaffe G . Retinopathy and optic neuropathy in bone marrow transplantation for breast cancer. Ophthalmology. 1996; 103(1):87-95. DOI: 10.1016/s0161-6420(96)30728-8. View

Roden D, Bosley T, Fowble B, Clark J, Savino P, Sergott R . Delayed radiation injury to the retrobulbar optic nerves and chiasm. Clinical syndrome and treatment with hyperbaric oxygen and corticosteroids. Ophthalmology. 1990; 97(3):346-51. DOI: 10.1016/s0161-6420(90)32582-4. View

Amoaku W, Archer D . Cephalic radiation and retinal vasculopathy. Eye (Lond). 1990; 4 ( Pt 1):195-203. DOI: 10.1038/eye.1990.26. View

Beck R, Maguire M, Bressler N, Glassman A, Lindblad A, Ferris F . Visual acuity as an outcome measure in clinical trials of retinal diseases. Ophthalmology. 2007; 114(10):1804-9. DOI: 10.1016/j.ophtha.2007.06.047. View

IRVINE A, Alvarado J, Wara W, Morris B, Wood I . Radiation retinopathy: an experimental model for the ischemic--proliferative retinopathies. Trans Am Ophthalmol Soc. 1981; 79:103-22. PMC: 1312177. View

. Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group. Arch Ophthalmol. 1985; 103(12):1796-806. View

10.

Slotman B, Faivre-Finn C, Kramer G, Rankin E, Snee M, Hatton M . Prophylactic cranial irradiation in extensive small-cell lung cancer. N Engl J Med. 2007; 357(7):664-72. DOI: 10.1056/NEJMoa071780. View

11.

. Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report no. 3. The Early Treatment Diabetic Retinopathy Study Research Group. Int Ophthalmol Clin. 1987; 27(4):254-64. DOI: 10.1097/00004397-198702740-00005. View

12.

Hykin P, Shields C, Shields J, Arevalo J . The efficacy of focal laser therapy in radiation-induced macular edema. Ophthalmology. 1998; 105(8):1425-9. DOI: 10.1016/S0161-6420(98)98023-X. View

13.

Egbert P, Fajardo L, Donaldson S, Moazed K . Posterior ocular abnormalities after irradiation for retinoblastoma: a histopathological study. Br J Ophthalmol. 1980; 64(9):660-5. PMC: 1043788. DOI: 10.1136/bjo.64.9.660. View

14.

Parsons J, Mendenhall W, Mancuso A, Cassisi N, Million R . Malignant tumors of the nasal cavity and ethmoid and sphenoid sinuses. Int J Radiat Oncol Biol Phys. 1988; 14(1):11-22. DOI: 10.1016/0360-3016(88)90044-2. View

15.

Gragoudas E, Li W, Lane A, Munzenrider J, Egan K . Risk factors for radiation maculopathy and papillopathy after intraocular irradiation. Ophthalmology. 1999; 106(8):1571-7; discussion 1577-8. DOI: 10.1016/S0161-6420(99)90455-4. View

16.

Lopez P, Sternberg Jr P, Dabbs C, VOGLER W, Crocker I, Kalin N . Bone marrow transplant retinopathy. Am J Ophthalmol. 1991; 112(6):635-46. DOI: 10.1016/s0002-9394(14)77269-1. View

17.

Quinn A, Clemett R . Retinopathy after low-dose retinal irradiation. Aust N Z J Ophthalmol. 1993; 21(3):193-7. View

18.

McDonald H, Schatz H . Grid photocoagulation for diffuse macular edema. Retina. 1985; 5(2):65-72. DOI: 10.1097/00006982-198500520-00001. View

19.

Kinyoun J, KALINA R, Brower S, Mills R, Johnson R . Radiation retinopathy after orbital irradiation for Graves' ophthalmopathy. Arch Ophthalmol. 1984; 102(10):1473-6. DOI: 10.1001/archopht.1984.01040031193016. View

20.

Kinyoun J, Lawrence B, Barlow W . Proliferative radiation retinopathy. Arch Ophthalmol. 1996; 114(9):1097-100. DOI: 10.1001/archopht.1996.01100140299007. View