Intravitreal aflibercept for the treatment of radiation-induced macular edema after ruthenium 106 plaque radiotherapy for choroidal melanoma

Graefes Arch Clin Exp Ophthalmol. 2019 Jul;257(7):1547-1554. doi: 10.1007/s00417-019-04347-6. Epub 2019 May 12.

Abstract

Purpose: To assess the efficacy of intravitreal aflibercept in patients suffering from post-radiation macular edema following plaque radiotherapy for choroidal melanoma.

Methods: This prospective, interventional case series included patients affected by radiation maculopathy (RM) with macular edema secondary to ruthenium-106 plaque brachytherapy for choroidal melanoma. The effect of intravitreal aflibercept on best-corrected visual acuity (BCVA), central foveal thickness (CFT) detected by spectral domain optical coherence tomography (sd-OCT), and Horgan's grading scale of RM was evaluated throughout the 24-month follow-up. Intraocular pressure (IOP) and possible complications were also recorded.

Results: Nine eyes of 9 patients were included. A mean of 4.4 ± 1.2 injections were given over the 24 months. At the end of follow-up, mean BCVA was significantly improved, from 0.9 ± 0.19 logMAR at baseline to 0.56 ± 0.3 logMAR (P = 0.028), and mean CFT was significantly decreased, from 546 ± 123 μm at baseline to 223 ± 34 μm (P < 0.001). Intravitreal aflibercept lowered baseline maculopathy stage as well. No significant change in IOP values and no complications, such as endophthalmitis, was recorded.

Conclusion: Intravitreal aflibercept is an effective treatment for patients with radiation-induced macular edema, allowing functional and anatomical improvements to be achieved with a relatively low number of injections.

Keywords: Intravitreal aflibercept; Plaque brachytherapy; Radiation maculopathy.

MeSH terms

  • Aged
  • Brachytherapy / adverse effects*
  • Choroid Neoplasms / diagnosis
  • Choroid Neoplasms / radiotherapy*
  • Dose-Response Relationship, Drug
  • Dose-Response Relationship, Radiation
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Fovea Centralis / pathology
  • Fovea Centralis / radiation effects
  • Fundus Oculi
  • Humans
  • Intravitreal Injections
  • Macular Edema / diagnosis
  • Macular Edema / drug therapy*
  • Macular Edema / etiology
  • Male
  • Melanoma / diagnosis
  • Melanoma / radiotherapy*
  • Middle Aged
  • Prospective Studies
  • Receptors, Vascular Endothelial Growth Factor / administration & dosage*
  • Receptors, Vascular Endothelial Growth Factor / antagonists & inhibitors
  • Recombinant Fusion Proteins / administration & dosage*
  • Ruthenium Radioisotopes / therapeutic use*
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity*

Substances

  • Recombinant Fusion Proteins
  • Ruthenium Radioisotopes
  • Ruthenium-106
  • aflibercept
  • Receptors, Vascular Endothelial Growth Factor