Antiangiogenic or Corticosteroid Treatment in Patients With Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma

Am J Ophthalmol. 2016 Aug:168:31-39. doi: 10.1016/j.ajo.2016.04.024. Epub 2016 May 7.

Abstract

Purpose: To reveal differences or advantages in regard to different treatment options after proton beam therapy for uveal melanoma.

Design: Retrospective, comparative, interventional case series.

Methods: All patients receiving intravitreal treatment between January 2011 and July 2014 for radiation maculopathy after proton beam therapy were included. Excluded were all patients who required re-irradiation, vitrectomies, or tumor resections; and those whose treatment was performed for potentially other reasons, such as radiation-induced optic neuropathy, or where visual outcome was influenced by tumor growth under the macula or macular ischemia. Minimum follow-up was 12 months after last injection.

Results: Of 78 patients, 38 (48.7%) received bevacizumab injections, 35 (44.9%) triamcinolone acetonide injections, and 5 (6.4%) a dexamethasone implant. In the bevacizumab group visual acuity improved in 11 patients (28.9%) by 0.25 logMAR (0.1-0.4 logMAR) and remained stable in 24 patients (63.2%) 4 weeks after injection. In the triamcinolone group visual acuity showed improved outcomes in 10 patients (28.6%) by 0.25 logMAR (0.1-0.4 logMAR) and stability in function in 20 patients (57.1%). Four weeks after dexamethasone implantation visual acuity remained stable in 4 patients (80%). No differences among the groups were detected regarding functional outcome or reduction in central foveal thickness.

Conclusions: This study showed that antiangiogenic or corticosteroid intravitreal treatment led to reduced central foveal thickness and visual improvement in some patients without showing differences or advantages. Therefore a patient-specific treatment choice can be recommended.

Publication types

  • Comparative Study

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Aged
  • Aged, 80 and over
  • Angiogenesis Inhibitors / therapeutic use*
  • Bevacizumab / therapeutic use
  • Dexamethasone / therapeutic use
  • Drug Implants
  • Female
  • Fovea Centralis / pathology
  • Glucocorticoids / therapeutic use*
  • Humans
  • Intravitreal Injections
  • Macula Lutea / pathology
  • Macular Edema / drug therapy
  • Male
  • Melanoma / radiotherapy
  • Middle Aged
  • Proton Therapy / adverse effects*
  • Radiation Injuries / drug therapy*
  • Retinal Diseases / drug therapy*
  • Retinal Diseases / etiology
  • Retinal Diseases / physiopathology
  • Retrospective Studies
  • Triamcinolone Acetonide / therapeutic use
  • Uveal Neoplasms / radiotherapy
  • Visual Acuity

Substances

  • Adrenal Cortex Hormones
  • Angiogenesis Inhibitors
  • Drug Implants
  • Glucocorticoids
  • Bevacizumab
  • Dexamethasone
  • Triamcinolone Acetonide

Supplementary concepts

  • Uveal melanoma