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Zhuang J, Yang Y, Liao Y, Li C, Wang WA, Luo X, Zhou H. Efficacy of Intravitreal Injections Anti-Vascular Endothelial Growth Factor Treatment for Radiation Retinopathy: A Systematic Review and Meta-analysis. Am J Ophthalmol 2024; 263:141-151. [PMID: 38458409 DOI: 10.1016/j.ajo.2024.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/10/2024]
Abstract
PURPOSE This study aims to appraise the therapeutic effectiveness of intravitreal injections anti-vascular endothelial growth factor (anti-VEGF) vs alternative therapies in managing radiation retinopathy (RR). DESIGN Systematic review and meta-analysis. METHODS We obtained comprehensive data retrieval using PubMed, Embase, Web of Science, Scopus, and the Cochrane Library from their inception until December 15, 2023. This review included randomized controlled trials (RCTs) and nonrandomized studies (NRSs) reporting on best-corrected visual acuity (BCVA) among RR patients treated with intravitreal anti-VEGF. Study selection and data extraction were meticulously performed by 2 independent reviewers. The Cochrane Risk of Bias Tool 2.0 (RoB 2.0) and Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) scales were utilized for bias risk assessment. Quantification of heterogeneity was executed using Q, H, and I2 statistics. The primary endpoint was the BCVA at the final observation point of each study. Secondary endpoints included central retinal thickness (CRT), foveal avascular zone (FAZ) area, and capillary density (CD) at the level of superficial capillary plexus. Subgroup analyses were undertaken to explore potential heterogeneity sources possibly due to treatment duration and study design. Sensitivity analyses were conducted to ascertain result stability. RESULTS This analysis incorporated 7 studies (including 3 RCTs) encompassing 922 patients afflicted with RR. Relative to other treatment modalities, intravitreal anti-VEGF therapy was associated with a statistically significant mean decrease in BCVA of -0.34 logMAR (95% CI, -0.39 to -0.30 logMAR; I2 = 87.70%; P < .001), and a substantial reduction in CRT of -34.65 µm (95% CI, -50.70 to -18.60 µm; I2 = 30.40%; P < .001). Additionally, a reduction in the FAZ area by -0.69 mm² (95% CI, -0.91 to -0.46 mm², I2 = 0%; P < .001) was observed. A positive tendency was noted in CD at the superficial capillary plexus between anti-VEGF and other therapeutic interventions. CONCLUSIONS Intravitreal anti-VEGF injections, in comparison to other treatments, demonstrate superior efficacy in enhancing BCVA and reducing CRT, thereby underscoring the potential of anti-VEGF in ameliorating radiation retinopathy outcomes. However, the conclusions are constrained by the incorporation of data from some NRSs and the small sample sizes.
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Affiliation(s)
- Jiayuan Zhuang
- School of Public Health & School of Nursing, Yangzhou University (J.Z., Y.L., C.L., W.W., H.Z.), Yangzhou, China; Clinical College of Chinese Medicine, Gansu University of Chinese Medicine (J.Z., X.L.), Lanzhou, China; Department of Ophthalmology, Gansu Provincial Hospital of TCM (J.Z., X.L.), Lanzhou, China
| | - Yang Yang
- School of Medicine, Yangzhou University (Y.Y., C.L.), Yangzhou, China
| | - Yuexia Liao
- School of Public Health & School of Nursing, Yangzhou University (J.Z., Y.L., C.L., W.W., H.Z.), Yangzhou, China
| | - Chenghao Li
- School of Public Health & School of Nursing, Yangzhou University (J.Z., Y.L., C.L., W.W., H.Z.), Yangzhou, China; School of Medicine, Yangzhou University (Y.Y., C.L.), Yangzhou, China
| | - Wen-An Wang
- School of Public Health & School of Nursing, Yangzhou University (J.Z., Y.L., C.L., W.W., H.Z.), Yangzhou, China; The First School of Clinical Medicine, Lanzhou University (W.W.), Lanzhou, China
| | - Xiangxia Luo
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine (J.Z., X.L.), Lanzhou, China; Department of Ophthalmology, Gansu Provincial Hospital of TCM (J.Z., X.L.), Lanzhou, China.
| | - Heng Zhou
- School of Public Health & School of Nursing, Yangzhou University (J.Z., Y.L., C.L., W.W., H.Z.), Yangzhou, China.
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Victor AA, Andayani G, Djatikusumo A, Yudantha AR, Hutapea MM, Gunardi TH, Soetjoadi H. Efficacy of Prophylactic Anti-VEGF in Preventing Radiation Retinopathy: A Systematic Review and Meta-Analysis. Clin Ophthalmol 2023; 17:2997-3009. [PMID: 37850047 PMCID: PMC10577260 DOI: 10.2147/opth.s433531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
Background In patients predisposed to radiation retinopathy (RR), administration of therapy after apparent clinical signs and symptoms are considered too late, resulting in substantial vision loss and blindness. Early initiation of anti-vascular endothelial growth factor (anti-VEGF) might serve as a strategy to slow disease progression and prolong good eyesight. Objective To evaluate the efficacy of prophylactic anti-VEGF in preventing RR and preserving vision in patients at high risk of radiation-induced vision loss. Methods A systematic literature search was performed from inception to 4 June 2023 using Cochrane Library, EMBASE, PubMed (MEDLINE), and Scopus. Eligible studies were clinical trials and observational studies investigating the incidence of radiation maculopathy (RM), radiation optic neuropathy (RON), moderate vision loss (loss of more than or equal to 3 lines of baseline visual acuity [VA]) and final VA, whether good (20/40 or better) or poor (20/200 or worse), following prophylactic anti-VEGF. Three reviewers independently conducted article screening, data extraction and risk of bias assessment. Random effects models were used to determine the cumulative effects of each outcome. Results Four studies (one clinical trial and three observational studies), involving 2109 patients, were included in our analysis. Across all studies, there were significant reductions in the events of RM (pooled odds ratio [OR] 0.50; 95% CI, 0.34-0.74; p = 0.001), RON (pooled OR 0.62; 95% CI, 0.42-0.90; p = 0.012) and poor final VA (pooled OR 0.50; 95% CI, 0.37-0.68; p = 0.003). The association of moderate vision loss and good final VA with the use of prophylactic anti-VEGF between the groups was unclear owing to the high level of heterogeneity. Conclusion Prophylactic anti-VEGF therapy might delay RM and RON, preventing high-risk patients from developing poor VA by approximately 50%. However, this evidence should be interpreted with caution because of its low level of certainty. Future robust studies are warranted to confirm this finding.
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Affiliation(s)
- Andi Arus Victor
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Gitalisa Andayani
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Ari Djatikusumo
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Anggun Rama Yudantha
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Mario Marbungaran Hutapea
- Department of Ophthalmology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
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Villegas NC, Mishra K, Steinle N, Liu W, Beadle B, Mruthyunjaya P. Intravitreal brolucizumab as treatment of early onset radiation retinopathy secondary to plaque brachytherapy for choroidal melanoma. Am J Ophthalmol Case Rep 2022; 27:101581. [PMID: 35599950 PMCID: PMC9121253 DOI: 10.1016/j.ajoc.2022.101581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 05/02/2022] [Accepted: 05/06/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose To describe the efficacy and safety of brolucizumab (Beovu®, Novartis Pharmaceuticals) in a case of cystoid macular edema associated with radiation retinopathy as a result of iodine-125 plaque brachytherapy (PBT) for choroidal melanoma, resistant to treatment with other anti-vascular endothelial growth factor (VEGF) agents. Observations A 67-year-old woman with choroidal melanoma in the right eye and best-corrected visual acuity (BCVA) of 20/20, underwent uncomplicated PBT. On post-operative month 7, the patient developed early onset radiation retinopathy. She failed to improve significantly with sub-tenon triamcinolone and 3 injections of intravitreal bevacizumab; BCVA was 20/200. Intravitreal brolucizumab was administered, and one month after, macular edema had resolved completely on optical coherence tomography, and BCVA improved to 20/50. At last follow up, 1 month after the third brolucizumab injection, BCVA was 20/60 and there was sustained resolution of intraretinal fluid. There were no signs of intraocular inflammation, progressive RR or optic neuropathy on exam or fluorescein angiography. Conclusions This case suggests a positive effect of brolucizumab in the management of radiation retinopathy following PBT refractory to other anti-VEGF agents. However, one must consider the risk of severe vision loss associated with retinal vasculitis from use of brolucizumab.
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Affiliation(s)
- Natacha C. Villegas
- Department of Ophthalmology, Stanford University School of Medicine, 2452, Watson Ct, Palo Alto, CA, United States
| | - Kapil Mishra
- Retina Service, Department of Ophthalmology, Stanford University School of Medicine, 2452, Watson Ct, Palo Alto, CA, United States
| | - Nathan Steinle
- California Retina Consultants, 525 E Micheltorena St A, Santa Barbara, CA, United States
| | - Wu Liu
- Department of Radiation Oncology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, United States
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, United States
| | - Prithvi Mruthyunjaya
- Department of Ophthalmology, Stanford University School of Medicine, 2452, Watson Ct, Palo Alto, CA, United States
- Department of Radiation Oncology, Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, United States
- Corresponding author. Department of Ophthalmology, Stanford University School of Medicine, 2452, Watson Ct, Palo Alto, CA, United States.
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4
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Gilli C, Thariat J, Chacun S, Nguyen AM, Loria O, Kodjikian L, Mathis T. [Radiation-induced retinopathy: actual knowledge and new concepts]. Cancer Radiother 2022; 26:1090-1099. [PMID: 35879145 DOI: 10.1016/j.canrad.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 10/16/2022]
Abstract
Radiation retinopathy is an occlusive vascular pathology following radiotherapy, generally targeted on the eye or peri-ocular structures. Despite increasingly precise techniques (stereotactic radiosurgery, proton therapy, etc.), the inclusion of the retina in the radiation field is sometimes unavoidable. This can lead to a severe pathology, which can ultimately cause blindness or even the anatomical loss of the eye when neovascular glaucoma occurs, due to the abnormal proliferation of neovessels. Radiation retinopathy have been described for more than a century, but it has recently seen great advances in both diagnosis and treatment. The advances of efficient and less invasive examinations in our clinical practice, such as OCT-angiography, allows for easier screening and diagnosis at earlier stages. Thus a new approach to the pathology is necessary, first of all through new definitions and classifications including previously undetected minimal forms. Furthermore, the recent appearance of intravitreal therapies by injection of anti-VEGF or dexamethasone implants has drastically changed the visual prognosis of these patients, who were previously treated only by retinal photocoagulation of the ischaemic areas. Recent studies have even shown the effectiveness of these new molecules in preventing the development of radiation retinopathy. This review of the literature provides an update on this disease and details how these recent diagnostic and therapeutic developments may play a role in the management of this complication.
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Affiliation(s)
- C Gilli
- Service d'Ophtalmologie, hôpital universitaire de la Croix-Rousse, hospices Civils de Lyon, 69317 Lyon, France
| | - J Thariat
- Laboratoire de physique Corpusculaire / IN2P3-CNRS UMR 6534 - ARCHADE, Unicaen - université de Normandie, 14000 Caen, France
| | - S Chacun
- Service d'Ophtalmologie, hôpital universitaire de la Croix-Rousse, hospices Civils de Lyon, 69317 Lyon, France
| | - A M Nguyen
- Service d'Ophtalmologie, hôpital universitaire de la Croix-Rousse, hospices Civils de Lyon, 69317 Lyon, France
| | - O Loria
- Service d'Ophtalmologie, hôpital universitaire de la Croix-Rousse, hospices Civils de Lyon, 69317 Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, université Lyon 1, 69100 Villeurbanne, France
| | - L Kodjikian
- Service d'Ophtalmologie, hôpital universitaire de la Croix-Rousse, hospices Civils de Lyon, 69317 Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, université Lyon 1, 69100 Villeurbanne, France
| | - T Mathis
- Service d'Ophtalmologie, hôpital universitaire de la Croix-Rousse, hospices Civils de Lyon, 69317 Lyon, France; UMR5510 MATEIS, CNRS, INSA Lyon, université Lyon 1, 69100 Villeurbanne, France.
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Chrząszcz M, Mackiewicz N, Pociej-Marciak W, Romanowska-Dixon B, Kubicka-Trząska A, Gawęcki M, Karska-Basta I. Diagnostic and Therapeutic Challenges in a Patient with Radiation Retinopathy Complicated by Corticosteroid-Induced Central Serous Chorioretinopathy. Medicina (B Aires) 2022; 58:medicina58070862. [PMID: 35888581 PMCID: PMC9323662 DOI: 10.3390/medicina58070862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Central serous chorioretinopathy (CSC) is a common chorioretinal disorder. It has been postulated that impaired retinal pigment epithelium and hyperpermeability of the choriocapillaris may be involved in the development of CSC, but the exact pathomechanism has not been established. We report an unusual case of a middle-aged man who developed CSC after triamcinolone acetonide injection for macular edema. Edema developed as a late complication of radiation retinopathy after brachytherapy for childhood retinoblastoma. Steroid treatment is an important risk factor for CSC, but the underlying causative mechanisms have not been fully elucidated. It is important to increase the awareness of this link among clinicians who prescribe exogenous corticosteroids, irrespective of the route of administration.
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Affiliation(s)
- Michał Chrząszcz
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-551 Cracow, Poland; (M.C.); (N.M.); (W.P.-M.); (B.R.-D.); (A.K.-T.)
| | - Natalia Mackiewicz
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-551 Cracow, Poland; (M.C.); (N.M.); (W.P.-M.); (B.R.-D.); (A.K.-T.)
| | - Weronika Pociej-Marciak
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-551 Cracow, Poland; (M.C.); (N.M.); (W.P.-M.); (B.R.-D.); (A.K.-T.)
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-551 Cracow, Poland; (M.C.); (N.M.); (W.P.-M.); (B.R.-D.); (A.K.-T.)
| | - Agnieszka Kubicka-Trząska
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-551 Cracow, Poland; (M.C.); (N.M.); (W.P.-M.); (B.R.-D.); (A.K.-T.)
| | - Maciej Gawęcki
- Dobry Wzrok Ophthalmological Clinic, 80-402 Gdańsk, Poland;
| | - Izabella Karska-Basta
- Department of Ophthalmology, Clinic of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-551 Cracow, Poland; (M.C.); (N.M.); (W.P.-M.); (B.R.-D.); (A.K.-T.)
- Correspondence:
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Binkley EM, Tamplin MR, Vitale AH, Boldt HC, Kardon RH, Grumbach IM. Longitudinal optical coherence tomography angiography (OCT-A) in a patient with radiation retinopathy following plaque brachytherapy for uveal melanoma. Am J Ophthalmol Case Rep 2022; 26:101508. [PMID: 35392251 PMCID: PMC8980489 DOI: 10.1016/j.ajoc.2022.101508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Patients with choroidal melanoma treated with brachytherapy lose vision over time due to radiation retinopathy and optic neuropathy. Newer imaging modalities such as optical coherence tomography angiography (OCT-A) may provide further insight into the ultrastructural vascular changes that occur over time. We studied the progressive OCT-A derived reduction in capillary density that occurred in the macula and juxtapapillary region of a patient treated with plaque brachytherapy for posterior uveal melanoma. Methods A patient with medium-sized choroidal melanoma in the inferonasal mid-periphery of the right eye was followed with OCT-A imaging in addition to standard imaging (color fundus photography, standardized echography, OCT) over a four-year time period following brachytherapy. Images were analyzed to measure vascular density in nine discrete areas of the macula at each time point as a function of region-specific radiation dose. Results OCT-A over time showed focal capillary loss and enlargement of the foveal avascular zone in addition to vascular re-modeling. These changes progressed over time despite improvement in the clinical markers of radiation retinopathy (cotton wool spots, retinal hemorrhages). Radiation dose significantly correlated with rate of reduction in vascular density assessed within 9 square sectors of the macula, and was greatest in sectors closest to the plaque, which had received the highest radiation dose. There was no change in the choriocapillaris flow area over time. The patient developed cystoid macular edema, but maintained 20/30 vision. Conclusions and Importance Longitudinal OCT-A demonstrates the microvascular changes that occur in response to radiation over time. Identification of these features may help define therapeutic windows to prevent vision loss associated with radiation retinopathy and optic neuropathy. Ongoing studies will describe a larger cohort of patients followed with this modality over time.
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Affiliation(s)
- Elaine M. Binkley
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Michelle R. Tamplin
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
| | - Anthony H. Vitale
- Abboud Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - H. Culver Boldt
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
| | - Randy H. Kardon
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA, USA
- Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
| | - Isabella M. Grumbach
- Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
- Abboud Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, IA, USA
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Thariat J, Martel A, Matet A, Loria O, Kodjikian L, Nguyen AM, Rosier L, Herault J, Nahon-Estève S, Mathis T. Non-Cancer Effects following Ionizing Irradiation Involving the Eye and Orbit. Cancers (Basel) 2022; 14:cancers14051194. [PMID: 35267502 PMCID: PMC8909862 DOI: 10.3390/cancers14051194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/14/2022] [Accepted: 02/24/2022] [Indexed: 12/04/2022] Open
Abstract
Simple Summary The irradiation of tumors involving the eye or orbit represents a complex therapeutic challenge due to the proximity between the tumor and organs that are susceptible to radiation. The challenges include tumor control, as it is often a surrogate for survival; organ (usually the eyeball) preservation; and the minimization of damage of sensitive tissues surrounding the tumor in order to preserve vision. Anticipation of the spectrum and severity of radiation-induced complications is crucial to the decision of which technique to use for a given tumor. The aim of the present review is to report the non-cancer effects that may occur following ionizing irradiation involving the eye and orbit and their specific patterns of toxicity for a given radiotherapy modality. The pros and cons of conventional and advanced forms of radiation techniques and their clinical implementation are provided with a clinical perspective. Abstract The eye is an exemplarily challenging organ to treat when considering ocular tumors. It is at the crossroads of several major aims in oncology: tumor control, organ preservation, and functional outcomes including vision and quality of life. The proximity between the tumor and organs that are susceptible to radiation damage explain these challenges. Given a high enough dose of radiation, virtually any cancer will be destroyed with radiotherapy. Yet, the doses inevitably absorbed by normal tissues may lead to complications, the likelihood of which increases with the radiation dose and volume of normal tissues irradiated. Precision radiotherapy allows personalized decision-making algorithms based on patient and tumor characteristics by exploiting the full knowledge of the physics, radiobiology, and the modifications made to the radiotherapy equipment to adapt to the various ocular tumors. Anticipation of the spectrum and severity of radiation-induced complications is crucial to the decision of which technique to use for a given tumor. Radiation can damage the lacrimal gland, eyelashes/eyelids, cornea, lens, macula/retina, optic nerves and chiasma, each having specific dose–response characteristics. The present review is a report of non-cancer effects that may occur following ionizing irradiation involving the eye and orbit and their specific patterns of toxicity for a given radiotherapy modality.
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Affiliation(s)
- Juliette Thariat
- Laboratoire de Physique Corpusculaire/IN2P3-CNRS UMR 6534—ARCHADE, Unicaen—Université de Normandie, 14000 Caen, France
- Correspondence: (J.T.); (T.M.)
| | - Arnaud Martel
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (A.M.); (S.N.-E.)
- Laboratoire de Pathologie Clinique et Expérimentale, Biobank BB-0033-00025, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
| | - Alexandre Matet
- Service d’Oncologie Oculaire, Institut Curie, 75005 Paris, France;
| | - Olivier Loria
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69317 Lyon, France; (O.L.); (L.K.); (A.-M.N.)
| | - Laurent Kodjikian
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69317 Lyon, France; (O.L.); (L.K.); (A.-M.N.)
- UMR-CNRS 5510 Matéis, 69100 Villeurbanne, France
| | - Anh-Minh Nguyen
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69317 Lyon, France; (O.L.); (L.K.); (A.-M.N.)
| | - Laurence Rosier
- Centre Rétine Galien, Centre d’Exploration et de Traitement de la Rétine et de la Macula, 33000 Bordeaux, France;
| | - Joël Herault
- Service de Radiothérapie, Centre Antoine Lacassagne, 06000 Nice, France;
| | - Sacha Nahon-Estève
- Service d’Ophtalmologie, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France; (A.M.); (S.N.-E.)
- INSERM, Biology and Pathologies of Melanocytes, Team1, Equipe labellisée Ligue 2020 and Equipe labellisée ARC 2019, Centre Méditerranéen de Médecine Moléculaire, 06200 Nice, France
| | - Thibaud Mathis
- Service d’Ophtalmologie, Hôpital Universitaire de la Croix-Rousse, Hospices Civils de Lyon, 69317 Lyon, France; (O.L.); (L.K.); (A.-M.N.)
- UMR-CNRS 5510 Matéis, 69100 Villeurbanne, France
- Correspondence: (J.T.); (T.M.)
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García-O'Farrill N, Pugazhendhi S, Karth PA, Hunter AA. Radiation retinopathy intricacies and advances in management. Semin Ophthalmol 2021; 37:417-435. [PMID: 34874814 DOI: 10.1080/08820538.2021.2000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Radiation retinopathy is a chronic, progressive, vision-threatening complication from exposure to various radiation sources. While several treatment modalities are available, proper management for this disease is a continuing challenge with no consensus on the most efficacious.Objective: The aim of this article is to provide an updated review of the published literature on the course of the disease, available treatments and their efficacies, frequency of regimen, core issues in patient management, and additional newer treatment modalities, including possible prophylactic approaches.Value: We also highlighted the challenges encountered with managing chronically treated patients through an analysis of a clinical case report on a patient who was treated for several years with different modalities after a diagnosis of radiation retinopathy.
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Affiliation(s)
- Noraliz García-O'Farrill
- Oregon Eye Consultants, Eugene, OR, USA.,Department of Ophthalmology, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
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Toro MD, Gozzo L, Tracia L, Cicciù M, Drago F, Bucolo C, Avitabile T, Rejdak R, Nowomiejska K, Zweifel S, Yousef YA, Nazzal R, Romano GL. New Therapeutic Perspectives in the Treatment of Uveal Melanoma: A Systematic Review. Biomedicines 2021; 9:biomedicines9101311. [PMID: 34680428 PMCID: PMC8533164 DOI: 10.3390/biomedicines9101311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/13/2022] Open
Abstract
Uveal melanoma (UM) is a rare disease, but the most common primary intraocular cancer, mostly localized in the choroid. Currently, the first-line treatment options for UM are radiation therapy, resection, and enucleation. However, although these treatments could potentially be curative, half of all patients will develop metastatic disease, whose prognosis is still poor. Indeed, effective therapeutic options for patients with advanced or metastatic disease are still lacking. Recently, the development of new treatment modalities with a lower incidence of adverse events, a better disease control rate, and new therapeutic approaches, have merged as new potential and promising therapeutic strategies. Additionally, several clinical trials are ongoing to find new therapeutic options, mainly for those with metastatic disease. Many interventions are still in the preliminary phases of clinical development, being investigated in phase I trial or phase I/II. The success of these trials could be crucial for changing the prognosis of patients with advanced/metastatic UM. In this systematic review, we analyzed all emerging and available literature on the new perspectives in the treatment of UM and patient outcomes; furthermore, their current limitations and more common adverse events are summarized.
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Affiliation(s)
- Mario Damiano Toro
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland; (M.D.T.); (S.Z.)
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland; (R.R.); (K.N.)
| | - Lucia Gozzo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.D.); (C.B.); (G.L.R.)
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, 95123 Catania, Italy
- Correspondence: ; Tel.: +39-095-3781757
| | - Luciano Tracia
- Plastic and Reconstructive Surgery Department, American Hospital Dubai, Dubai, United Arab Emirates;
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, AOU ‘G. Martino’, 98124 Messina, Italy;
| | - Filippo Drago
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.D.); (C.B.); (G.L.R.)
- Clinical Pharmacology Unit, Regional Pharmacovigilance Centre, University Hospital of Catania, 95123 Catania, Italy
- Centre for Research and Consultancy in HTA and Drug Regulatory Affairs (CERD), University of Catania, 95123 Catania, Italy
| | - Claudio Bucolo
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.D.); (C.B.); (G.L.R.)
- Center of Research in Ocular Pharmacology—CERFO, University of Catania, 95123 Catania, Italy
| | - Teresio Avitabile
- Department of Ophthalmology, University of Catania, 95123 Catania, Italy;
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland; (R.R.); (K.N.)
| | - Katarzyna Nowomiejska
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20079 Lublin, Poland; (R.R.); (K.N.)
| | - Sandrine Zweifel
- Department of Ophthalmology, University of Zurich, 8091 Zurich, Switzerland; (M.D.T.); (S.Z.)
| | - Yacoub A. Yousef
- Department of Surgery/Ophthalmology, King Hussein Cancer Center, Amman 11941, Jordan;
| | | | - Giovanni Luca Romano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy; (F.D.); (C.B.); (G.L.R.)
- Center of Research in Ocular Pharmacology—CERFO, University of Catania, 95123 Catania, Italy
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10
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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] [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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van Beek JGM, van Rij CM, Baart SJ, Yavuzyigitoglu S, Bergmann MJ, Paridaens D, Naus NC, Kiliç E. Fractionated stereotactic radiotherapy for uveal melanoma: Long-term outcome and control rates. Acta Ophthalmol 2021; 100:511-519. [PMID: 34529346 PMCID: PMC9544756 DOI: 10.1111/aos.15029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/07/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
Purpose The aim of our study is to evaluate local tumour control rates, radiation side‐effects, visual preservation and disease‐free survival (DFS) of uveal melanoma (UM) patients treated with fractionated stereotactic radiotherapy (fSRT). Methods A retrospective study of UM patients, who were treated with fSRT (N = 189), was performed by the Rotterdam Ocular Melanoma Study group (ROMS), the Netherlands, between 1999 and 2014 with a follow‐up of at least 5 years. Results The 1‐, 3‐, 5‐, 10‐ and 15‐year local tumour control rates were as follows: 99.4%, 92.8%, 92.2%, 89.3% and 89.3%, respectively. Cataract (67.8%) was the most common side‐effect of fSRT followed by retinopathy (35.1%), maculopathy (23.8%), vitreous haemorrhage (20.1%), neovascular glaucoma (NVG) (20.0%) and optic neuropathy (12.4%). Patients with anterior located UMs developed cataract more frequently (p = 0.047, multivariable analysis). By multivariable analysis, significant factors for secondary enucleation were tumour recurrence (p < 0.001) and NVG (p < 0.001). In multivariable analysis, risk factors for a worse DFS were larger UM (p = 0.024) and tumours with subretinal fluid (SRF) at baseline (p = 0.038). The 5‐year DFS was 77.0% and the best corrected visual acuity decreased significantly after treatment. After 5 years, 22.0% of patients and after 10 years 17.6% of patients had a visual acuity of ≤0.3 logMAR. Conclusion Fractionated stereotactic radiotherapy is a good treatment option for small‐, medium‐ and large‐sized tumours with 5‐year local tumour control of 92.2%. After 5 years, 22.0% of the patients had a good vision. Independently of tumour location, the visual acuity decreased significantly after treatment. Overall, the 5‐year DFS was 77.0%.
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Affiliation(s)
- Jackelien G. M. van Beek
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
- Department of Ophthalmology Ikazia Hospital Rotterdam The Netherlands
- ‘Oog op Zuid’ Eye Clinic Rotterdam The Netherlands
| | - Caroline M. van Rij
- Department of Radiotherapy Erasmus University Medical Centre Rotterdam The Netherlands
| | - Sara J. Baart
- Department of Biostatistics Erasmus University Medical Centre Rotterdam The Netherlands
| | - Serdar Yavuzyigitoglu
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
| | - Michael J. Bergmann
- Department of Ophthalmology Albert Schweitzer Hospital Dordrecht The Netherlands
| | - Dion Paridaens
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
- Oculoplastic and Orbital surgery Rotterdam Eye Hospital Rotterdam The Netherlands
| | - Nicole C. Naus
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
| | - Emine Kiliç
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
- Department of Clinical Genetics Erasmus University Medical Centre Rotterdam The Netherlands
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12
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Eandi CM, Polito MS, Schalenbourg A, Zografos L. EIGHTEEN-MONTH RESULTS OF INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR ON VISION AND MICROCIRCULATION IN RADIATION MACULOPATHY. Retina 2021; 41:1883-1891. [PMID: 33411473 PMCID: PMC8384245 DOI: 10.1097/iae.0000000000003105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate 18 months' results of a strict anti-vascular endothelial growth factor protocol for radiation maculopathy following proton therapy in choroidal melanoma. METHODS Retrospective, comparative, nonrandomized study of 74 radiation maculopathy patients presenting macular lipid deposits, hemorrhages, microaneurysms, cystoid edema, nerve layer infarction, telangiectasia, or capillary nonperfusion. The study group included 52 consecutive patients injected with intravitreal anti-vascular endothelial growth factors (bevacizumab/ranibizumab: 46/6) every two months for the first and every 3 months for the second year, with minimum 12 months' follow-up. The control group consisted of 22 patients having declined this treatment. Best-corrected visual acuity, spectral domain-optical coherence tomography and optical coherence tomography angiography were recorded at baseline, 6, 12, and 18 months. The foveal avascular zone and capillary density were measured at the superficial capillary plexus. RESULTS Radiation maculopathy was diagnosed at 2 years (1.5-3.5) after proton therapy. Best-corrected visual acuity at baseline, 12 and 18 months improved in the study group from 0.45, 0.3 to 0.2 logarithm of the minimum angle of resolution, but decreased in the control group from 0.5, 0.9 to 1.0 logarithm of the minimum angle of resolution respectively (P < 0.001 at 12 months). Simultaneously, foveal avascular zone enlargement was less in the study (from 0.377, 0.665 to 0.744 mm2) than control group (from 0.436, 1.463 to 2.638 mm2) (P = 0.05 at 12 months). CMT (280 and 276 µm) and capillary density (37% and 38%, at baseline, respectively) did not evolve significantly different. CONCLUSION Intravitreal anti-vascular endothelial growth factors, every 2 months for the first and every 3 months for the second year, slow down, over up to 18 months, vision loss and anatomical degradation in radiation maculopathy following proton therapy for choroidal melanoma.
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Affiliation(s)
- Chiara M. Eandi
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland; and
- Department of Surgical Science, University of Torino, Torino, Italy
| | - Maria S. Polito
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland; and
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland; and
| | - Leonidas Zografos
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland; and
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13
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Murray TG, Villegas VM, Bach A, Gold AS. Five-Year Follow-up of Microincisional Vitrectomy Surgery, Endolaser Tumor Ablation, and Gene-Expression Profiling in Small Uveal Melanoma. JOURNAL OF VITREORETINAL DISEASES 2021; 5:298-303. [PMID: 37007596 PMCID: PMC9976242 DOI: 10.1177/2474126420972878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: This work evaluates a microincisional vitrectomy surgical (MIVS) approach to endolaser ablation of small uveal malignant melanoma by incorporating genetic tumor classification as a means to avoid radiotherapy while maintaining local tumor control without compromising visual acuity (VA). Methods: An institutional review board–approved, single-surgeon, retrospective analysis was conducted of a consecutive case series of all patients with tumors less than 2.5 mm in apical thickness who underwent MIVS, endolaser tumor ablation, fine-needle aspiration biopsy (FNAB), and intravitreal triamcinolone acetonide for small uveal melanoma between 2012 and 2015. Results: A total of 226 patients underwent FNAB from January 2012 to January 2015 for uveal melanoma. All 58 patients treated for a small uveal melanoma were included. This group of patients had a minimum follow-up of 60 months (range, 60-93 months). At initial diagnosis, subretinal fluid was present in 52 eyes (89.1%), macular edema was present in 24 eyes (41.4%), and epiretinal membrane was present in 11 eyes (20.1%). Fifty-six specimens (96.5%) received a molecular classification of either class 2 (4 of 56, 7.1%) or class 1 (52 of 56, 92.8%). Initial VA was 20/40 or better in 26 eyes (44.8%), and final VA was 20/40 or better in 48 of 58 eyes (82.8%). Conclusions: Endolaser tumor ablation delivered at MIVS surgery enables excellent tumor control (98.3%) and improves VA to better than 20/40 in more than 80% of treated eyes. FNAB achieves molecular classification in 96.5% of all patients undergoing treatment for small choroidal melanoma independent of tumor size.
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Affiliation(s)
- Timothy G. Murray
- Miami Ocular Oncology and Retina, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Victor M. Villegas
- Miami Ocular Oncology and Retina, Miami, FL, USA
- Department of Ophthalmology, University of Puerto Rico, San Juan, Puerto Rico, USA
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Abstract
Retinoblastoma in children and uveal melanoma in adults can pose a serious threat to both vision and life. For many decades, enucleation was often the only option to treat these intraocular malignancies. For retinoblastoma, intra-arterial chemotherapy is often utilized as the primary treatment at advanced academic centers and has dramatically improved local tumor control and eye salvage rates. For uveal melanoma, both plaque brachytherapy and proton beam irradiation have served as widely utilized therapies with a local failure rate of approximately 1–10%, depending on the series. Major recent advancements have allowed for a better understanding of the genomics of uveal melanoma and the impact of certain mutations on metastatic susceptibility. Gene expression profile stratifies uveal melanomas into two classes: low-risk (class 1) and high-risk (class 2). A loss-of-function mutation of BAP1 is associated with a class 2 gene expression profile and therefore confers worse prognosis due to elevated risk of metastasis. On the other hand, gain-of-function mutations of EIF1AX and SF3B1 correspond to a gene expression profile of class 1A and class 1B and confer a better prognosis. Preferentially expressed antigen in melanoma (PRAME) is an antigen that increases metastatic susceptibility when expressed in uveal melanoma cells. In addition to plaque brachytherapy and proton beam irradiation, both of which have demonstrated superb clinical outcomes, scientists are actively investigating newer therapeutic modalities as either primary therapy or adjuvant treatment, including a novel nanoparticle therapy and immunotherapy.
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Affiliation(s)
- Amy C Schefler
- Retina Consultants of Texas, Houston, Texas, USA
- Blanton Eye Institute, Houston, Texas, USA
| | - Ryan S Kim
- Retina Consultants of Texas, Houston, Texas, USA
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, USA
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15
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D'Aguanno S, Mallone F, Marenco M, Del Bufalo D, Moramarco A. Hypoxia-dependent drivers of melanoma progression. J Exp Clin Cancer Res 2021; 40:159. [PMID: 33964953 PMCID: PMC8106186 DOI: 10.1186/s13046-021-01926-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/23/2021] [Indexed: 02/07/2023] Open
Abstract
Hypoxia, a condition of low oxygen availability, is a hallmark of tumour microenvironment and promotes cancer progression and resistance to therapy. Many studies reported the essential role of hypoxia in regulating invasiveness, angiogenesis, vasculogenic mimicry and response to therapy in melanoma. Melanoma is an aggressive cancer originating from melanocytes located in the skin (cutaneous melanoma), in the uveal tract of the eye (uveal melanoma) or in mucosal membranes (mucosal melanoma). These three subtypes of melanoma represent distinct neoplasms in terms of biology, epidemiology, aetiology, molecular profile and clinical features.In this review, the latest progress in hypoxia-regulated pathways involved in the development and progression of all melanoma subtypes were discussed. We also summarized current knowledge on preclinical studies with drugs targeting Hypoxia-Inducible Factor-1, angiogenesis or vasculogenic mimicry. Finally, we described available evidence on clinical studies investigating the use of Hypoxia-Inducible Factor-1 inhibitors or antiangiogenic drugs, alone or in combination with other strategies, in metastatic and adjuvant settings of cutaneous, uveal and mucosal melanoma.Hypoxia-Inducible Factor-independent pathways have been also reported to regulate melanoma progression, but this issue is beyond the scope of this review.As evident from the numerous studies discussed in this review, the increasing knowledge of hypoxia-regulated pathways in melanoma progression and the promising results obtained from novel antiangiogenic therapies, could offer new perspectives in clinical practice in order to improve survival outcomes of melanoma patients.
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Affiliation(s)
- Simona D'Aguanno
- Preclinical Models and New Therapeutic Agents Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabiana Mallone
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Marco Marenco
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Donatella Del Bufalo
- Preclinical Models and New Therapeutic Agents Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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16
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Murray TG, Latiff A, Villegas VM, Gold AS. Aflibercept for Radiation Maculopathy (ARM Study): Year-2 Extension of a Prospective Clinical Study. JOURNAL OF VITREORETINAL DISEASES 2021; 5:232-238. [PMID: 37006513 PMCID: PMC9979042 DOI: 10.1177/2474126420958894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: This work describes the 2-year results of the Aflibercept for Radiation Maculopathy (ARM) randomized clinical study that evaluated intravitreal vascular endothelial growth factor antagonist therapy in radiation maculopathy delivering aflibercept using a second-year collapsed, every-6-weeks, treat-and-adjust interval. Methods: Forty patients were enrolled in an institutional review board–approved clinical trial and randomly assigned to aflibercept treatment via 1 of 2 regimens: fixed, every-6-week treatment or variable, treat-and-adjust therapy centered around 6 weeks. All patients had a diagnosis of treated uveal melanoma with documented tumor control, and they had visually compromising radiation maculopathy. At conclusion of year 1, the first 30 patients were offered a collapsed single-arm variable of an every-6-weeks treat-and-adjust aflibercept injection schedule for an additional treatment year. Results: Baseline best-corrected visual acuity (BCVA) was 20/63 at ARM study entry 20/62 at the institution of the year-2 extension. At ARM study entry baseline, spectral domain–optical coherence tomography mean central retinal thickness was 432 µm and was 294 µm at the same institution. At the 2-year study’s conclusion, 76.7% (23 of 30) of eyes were better than 20/50, and only 6.7% (2 of 30) ended with a BCVA below 20/200. Final mean BCVA was 20/62 and final mean spectral domain–optical coherence tomography central retinal thickness was 286 µm, but as in year 1, this reduction in number of injections was not statistically significant. Conclusions: Aflibercept is effective in treating radiation maculopathy with maintained visual acuity at 2 years but continues to require an ongoing treatment approach to stabilize radiation maculopathy.
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Affiliation(s)
- Timothy G. Murray
- Murray Ocular Oncology and Retina, Miami, FL, USA
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Victor M. Villegas
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, University of Puerto Rico, San Juan, PR, USA
- Department of Surgery, Ponce Health Sciences University, Ponce, PR, USA
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17
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van Beek JGM, Ramdas WD, Angi M, van Rij CM, Naus NC, Kacperek A, Errington RD, Damato B, Heimann H, Kiliç E. Local tumour control and radiation side effects for fractionated stereotactic photon beam radiotherapy compared to proton beam radiotherapy in uveal melanoma. Radiother Oncol 2021; 157:219-224. [PMID: 33549643 DOI: 10.1016/j.radonc.2021.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the adverse side effects of fractionated stereotactic photon beam radiotherapy (fSRT) with proton beam radiotherapy (PBR) in patients with uveal melanoma (UM). METHODS A retrospective study investigating 306 UM patients treated with fSRT (N=153) by the Rotterdam Ocular Melanoma Study group (ROMS), The Netherlands, between 1999-2014 or with PBR (N=153) at the Royal Liverpool University Hospital and the Clatterbridge Cancer Centre, Bebington, United Kingdom, between 1993-2014. The tumours treated with fSRT were matched with tumours treated with PBR based on sex, left or right eye, TNM classification, posterior margin ≤ or > 3mm of the fovea and of the optic disc. RESULTS The five-year actuarial rates of tumour recurrence were 4.5% for fSRT and 6.1% for PBR. For fSRT and PBR, the five-year actuarial rates of maculopathy were 14.9% and 12.4%, and for vitreous haemorrhage were 29.4% and 4.7%, respectively. Only vitreous haemorrhage (HR: 0.19, 95% CI: 0.07-0.56) was more common after fSRT compared to PBR. Overall, larger tumours were risk factors for maculopathy and secondary enucleation. CONCLUSIONS Both treatments have excellent local tumour control. In matched groups, vitreous haemorrhage was the only adverse side effect showing a significant difference between groups.
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Affiliation(s)
- Jackelien G M van Beek
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands.
| | - Wishal D Ramdas
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Martina Angi
- Ocular Oncology Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Ocular Oncology Service, Department of Ophthalmology, Royal Liverpool University Hospital, United Kingdom
| | - Caroline M van Rij
- Department of Radiotherapy, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Nicole C Naus
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | | | | | - Bertil Damato
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Heinrich Heimann
- Ocular Oncology Service, Department of Ophthalmology, Royal Liverpool University Hospital, United Kingdom
| | - Emine Kiliç
- Department of Ophthalmology, Erasmus University Medical Centre, Rotterdam, the Netherlands; Department of Clinical Genetics, Erasmus University Medical Centre, Rotterdam, the Netherlands.
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18
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Green KM, Toy BC, Ashimatey BS, Mustafi D, Jennelle RL, Astrahan MA, Chu Z, Wang RK, Kim J, Berry JL, Kashani AH. Quantifying Subclinical and Longitudinal Microvascular Changes Following Episcleral Plaque Brachytherapy Using Spectral Domain-Optical Coherence Tomography Angiography. JOURNAL OF VITREORETINAL DISEASES 2020; 4:499-508. [PMID: 33409441 PMCID: PMC7785061 DOI: 10.1177/2474126420936199] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess longitudinal microvascular changes in eyes treated with I-125 episcleral plaque brachytherapy (EPB). METHODS High resolution OCT angiograms of the central 3×3mm macula were obtained from I-125 episcleral plaque brachytherapy treated and untreated fellow eyes of 61 patients. Capillary density (vessel skeleton density, VSD) and caliber (vessel diameter index, VDI) were quantified using previously validated semi-automated algorithms. Nonperfusion was also quantified as flow impairment regions (FIR). Exams from treated and fellow eyes obtained pre-treatment and at 6-month, 1-year, and 2-year intervals were compared using generalized estimating equation linear models. Dosimetry maps were used to evaluate spatial correlation between radiation dose and microvascular metrics. RESULTS At 6 months, treated eyes had significantly lower VSD (0.145 ± 0.003 vs 0.155 ± 0.002; p = 0.009) and higher FIR (2.01 ± 0.199 vs 1.46 ± 0.104; p = 0.010) compared to fellow eyes. There was a significant decrease in VSD and a corresponding increase in FIR even for treated eyes without clinically identifiable retinopathy at 6 months. VDI was significantly higher in treated eyes than in fellow eyes at 2 years (2.92 ± 0.025 vs 2.84 ± 0.018; p < 0.001). When our cohort was categorized into low dose radiation (<15Gy) and high dose radiation (>45Gy) to the fovea, there were significant differences in VSD and FIR between groups. CONCLUSIONS OCTA can be used to quantify and monitor EPB induced retinopathy, and can detect vascular abnormalities even in the absence of clinically observable retinopathy. OCTA may therefore be useful in investigating treatment interventions that aim to delay EPB-induced radiation retinopathy.
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Affiliation(s)
- Kyle M. Green
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Brian C. Toy
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Bright S. Ashimatey
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Debarshi Mustafi
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Richard L. Jennelle
- Department of Radiation Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Melvin A. Astrahan
- Department of Radiation Oncology, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Zhongdi Chu
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, Washington.,Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Jonathan Kim
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA.,The Vision Center, Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA
| | - Jesse L. Berry
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA.,The Vision Center, Children’s Hospital Los Angeles, Keck School of Medicine, Los Angeles, CA
| | - Amir H. Kashani
- USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA.,USC Ginsberg Institute for Biomedical Therapeutics, University of Southern California, Los Angeles, CA
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19
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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] [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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Cennamo G, Montorio D, Bernardo R, Farella A, Liuzzi R, Breve MA, Reibaldi M, Cennamo G. Retinal Vascular Changes in Radiation Maculopathy after Intravitreal Ranibizumab by Optical Coherence Tomography Angiography. J Clin Med 2020; 9:jcm9061618. [PMID: 32471149 PMCID: PMC7356529 DOI: 10.3390/jcm9061618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 11/16/2022] Open
Abstract
In this prospective study, we investigated the structural and vascular retinal changes at baseline and after Ranibizumab injections at the last follow up to one year in patients affected by Radiation Maculopathy (RM) after plaque brachytheraphy in choroidal melanoma, using Spectral Domain Optical Coherence Tomography (SD-OCT) and OCT Angiography (OCTA). A total of 40 eyes with RM of 40 patients (18 females, 22 males, mean age 51.9 ± 11 years) that underwent ruthenium-106 plaque brachytherapy were included. All patients received one monthly intravitreal injection of Ranibizumab (Pro Re Nata regimen). We analyzed the Foveal Avascular Zone (FAZ) area, the retinal vessel density (VD) of the superficial capillary plexus (SCP) and of the deep capillary plexus (DCP), using OCTA, and we detected the Central Foveal Thickness (CFT) by SD-OCT at baseline and after treatment. At the last follow up, we found a significant improvement of the CFT (p < 0.001) while OCTA parameters revealed no change in VD of the SCP (p = 0.402), DCP (p = 0.282), and FAZ area (p = 0.255), resulting in a stabilization of the visual acuity (p = 0.210) respect to baseline. The absence of functional improvement, despite the anatomical recovery of the macula, could be due to the absence of improvement in FAZ area and in retinal VD after treatment. OCTA parameters could represent predictive biomarkers to anti-vascular endothelial growth factor (anti-VEGF) intravitreal response and to help to better understand the physiopathological mechanisms of the RM.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Public Health Department, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Roberta Bernardo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Antonio Farella
- Functional and Morphologic Department of Radiotherapy and Legal Medicine, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council (CNR), 80145 Naples, Italy;
| | - Maria Angelica Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
| | - Michele Reibaldi
- Department of Surgical Sciences, University of Torino, 10124 Torino, Italy
- Correspondence:
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples “Federico II”, 80131 Naples, Italy; (D.M.); (R.B.); (M.A.B.); (G.C.)
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Rayess N, Mruthyunjaya P. Anti-Vascular Endothelial Growth Factor Therapy for Radiation Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2020; 51:S44-S49. [PMID: 32348534 DOI: 10.3928/23258160-20200401-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 01/23/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The purpose of this article is to review the role of anti-vascular endothelial growth factor (VEGF) therapy in treating patients with radiation retinopathy (RR). PATIENTS AND METHODS RR can be associated with a significant decrease in visual acuity (VA) related to the development of cystoid macular edema, macular ischemia, and proliferative retinopathy leading to neovascular glaucoma. RESULTS Anti-VEGF therapy is effective at stabilizing VA in around 80% of patients and achieving reductions in central macular thickness when it is administered using a constant algorithm. Furthermore, consistent prophylactic anti-VEGF therapy reduces the risk of development of RR, neovascularization of the iris, and neovascularization glaucoma. CONCLUSION Future studies are needed to determine the optimal regimen for anti-VEGF therapy according to patient risk factors and likelihood of developing RR. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:S44-S49.].
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Boldt HC, Murray TG, Binkley EM. Studies Evaluating Visual Outcomes After Brachytherapy in Uveal Melanoma—Strengths and Limitations of Current Investigations. JAMA Ophthalmol 2020; 138:146-147. [DOI: 10.1001/jamaophthalmol.2019.5122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- H. Culver Boldt
- University of Iowa Department of Ophthalmology and Visual Sciences, Carver College of Medicine, Iowa City
| | - Timothy G. Murray
- Miami Ocular Oncology and Retina, Bascom Palmer Eye Institute, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Elaine M. Binkley
- University of Iowa Department of Ophthalmology and Visual Sciences, Carver College of Medicine, Iowa City
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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] [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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