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

Nisha V Shah,1 Samuel K Houston,1 Arnold M Markoe,2 William Feuer,3 Timothy G Murray1,2,41Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Department of Radiation Oncology, University of Miami Miller School of Medicine, 3Department of Biostati...

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Autores principales:	Shah NV, Houston SK, Markoe AM, Feuer W, Murray TG
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2012
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/f38d19f857da47dcb354e5b4102608bf
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spelling	oai:doaj.org-article:f38d19f857da47dcb354e5b4102608bf2021-12-02T01:52:54ZEarly SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity1177-54671177-5483https://doaj.org/article/f38d19f857da47dcb354e5b4102608bf2012-10-01T00:00:00Zhttp://www.dovepress.com/early-sd-oct-diagnosis-followed-by-prompt-treatment-of-radiation-macul-a11383https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Nisha V Shah,1 Samuel K Houston,1 Arnold M Markoe,2 William Feuer,3 Timothy G Murray1,2,41Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Department of Radiation Oncology, University of Miami Miller School of Medicine, 3Department of Biostatistics, University of Miami, 4Murray Ocular Oncology and Retina, Miami, FL, USAPurpose: 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&ndash;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&ndash;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 &lt; 0.0001). These 81 patients were given a mean of five injections (range 1&ndash;17) over a mean of 17.6 months (range 1&ndash;54 months), starting at 15.8 months (range 3&ndash;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.Keywords: intravitreal bevacizumab, plaque brachytherapy, BCVA, radiation maculopathy, uveal melanomaShah NVHouston SKMarkoe AMFeuer WMurray TGDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2012, Iss default, Pp 1739-1748 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Shah NV Houston SK Markoe AM Feuer W Murray TG Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
description	Nisha V Shah,1 Samuel K Houston,1 Arnold M Markoe,2 William Feuer,3 Timothy G Murray1,2,41Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 2Department of Radiation Oncology, University of Miami Miller School of Medicine, 3Department of Biostatistics, University of Miami, 4Murray Ocular Oncology and Retina, Miami, FL, USAPurpose: 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&ndash;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&ndash;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 &lt; 0.0001). These 81 patients were given a mean of five injections (range 1&ndash;17) over a mean of 17.6 months (range 1&ndash;54 months), starting at 15.8 months (range 3&ndash;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.Keywords: intravitreal bevacizumab, plaque brachytherapy, BCVA, radiation maculopathy, uveal melanoma
format	article
author	Shah NV Houston SK Markoe AM Feuer W Murray TG
author_facet	Shah NV Houston SK Markoe AM Feuer W Murray TG
author_sort	Shah NV
title	Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
title_short	Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
title_full	Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
title_fullStr	Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
title_full_unstemmed	Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
title_sort	early sd-oct diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity
publisher	Dove Medical Press
publishDate	2012
url	https://doaj.org/article/f38d19f857da47dcb354e5b4102608bf
work_keys_str_mv	AT shahnv earlysdoctdiagnosisfollowedbyprompttreatmentofradiationmaculopathyusingintravitrealbevacizumabmaintainsfunctionalvisualacuity AT houstonsk earlysdoctdiagnosisfollowedbyprompttreatmentofradiationmaculopathyusingintravitrealbevacizumabmaintainsfunctionalvisualacuity AT markoeam earlysdoctdiagnosisfollowedbyprompttreatmentofradiationmaculopathyusingintravitrealbevacizumabmaintainsfunctionalvisualacuity AT feuerw earlysdoctdiagnosisfollowedbyprompttreatmentofradiationmaculopathyusingintravitrealbevacizumabmaintainsfunctionalvisualacuity AT murraytg earlysdoctdiagnosisfollowedbyprompttreatmentofradiationmaculopathyusingintravitrealbevacizumabmaintainsfunctionalvisualacuity
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Early SD-OCT diagnosis followed by prompt treatment of radiation maculopathy using intravitreal bevacizumab maintains functional visual acuity

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