Multimodal imaging in radiation retinopathy following orbital metastasis
Medical hypothesis, discovery & innovation in optometry,
Vol. 4 No. 3 (2023),
3 October 2023
,
Page 141-147
https://doi.org/10.51329/mehdioptometry184
Abstract
Background: Radiation retinopathy is a major cause of vision loss in patients receiving radiotherapy to the head and orbit. Diabetic retinopathy is one of the differential diagnosis owing to similar clinical features, including microaneurysms, cotton-wool spots, hard exudates, and macular edema. The only significant pathological difference is that radiation retinopathy spares pericytes, unlike in diabetic retinopathy. Multimodal imaging helps diagnose and predict the prognosis of radiation retinopathy, which is presented in this case report.Case Presentation: A 55-year-old woman diagnosed with stage-4 metastatic breast carcinoma presented with gradual diminution of vision in the left eye (OS) over 5 months. Vision in the right eye was lost because of orbital radiotherapy for orbital metastasis. The patient underwent multiple sessions of chemotherapy and radiotherapy. Examination of the left eye revealed a best-corrected distance visual acuity (BCDVA) of 20/30. Fundus examination of the OS revealed multiple cotton-wool spots and retinal hemorrhages. Fundus fluorescein angiography (FFA) showed diffuse macular leakage with capillary nonperfusion. Multicolor imaging (MCI) with Spectralis™ revealed black dots in the blue and green reflectance images, corresponding to capillary dilatation on FFA. Darker dots were more evident in the infrared images. BCDVA improved to 20/20 in OS after tapering the dose of oral steroids for 2 months, with improvements in hemorrhages and cotton-wool spots. Focal laser photocoagulation was recommended for the treatment of persistent macular edema. The patient declined further treatment, was lost to follow-up, and passed away 6 months later.
Conclusions: This case highlights the importance of multimodal imaging for the identification and classification of radiation retinopathy. MCI using SpectralisTM has been described for the first time in radiation retinopathy and can be used to complement existing imaging modalities. Future studies involving more patients and a longer follow-up duration may provide better results for the applicability of these imaging modalities in the clinical setting.
Keywords:
- radiations
- macula luteas
- imaging
- multimodal
- multimodal imaging
- multi-color imaging
- fluorescence angiography
- optical coherence tomography
- cystoid macular edema
References
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2. Sabaner MC, Dogan M. Treatment of Intravitreal Ranibizumab Resistant Radiation Retinopathy with Intravitreal Dexamethasone Implant: A Case Report. Beyoglu Eye J. 2022;7(4):324-328. doi: 10.14744/bej.2022.72602 pmid: 36628082
3. Ozcan G, Gunduz AK, Mirzayev I, Oysul K, Uysal H. Early Results of Stereotactic Radiosurgery in Uveal Melanoma and Risk Factors for Radiation Retinopathy. Turk J Ophthalmol. 2020;50(3):156-162. doi: 10.4274/tjo.galenos.2019.78370 pmid: 32631003
4. Kinyoun JL. Long-term visual acuity results of treated and untreated radiation retinopathy (an AOS thesis). Trans Am Ophthalmol Soc. 2008;106:325-35 pmid: 19277244
5. Groenewald C, Konstantinidis L, Damato B. Effects of radiotherapy on uveal melanomas and adjacent tissues. Eye (Lond). 2013;27(2):163-71. doi: 10.1038/eye.2012.249 pmid: 23196647
6. Wen JC, Oliver SC, McCannel TA. Ocular complications following I-125 brachytherapy for choroidal melanoma. Eye (Lond). 2009;23(6):1254-68. doi: 10.1038/eye.2009.43 pmid: 19265865
7. Uzun S, Toyran S, Akay F, Gundogan FC. Delayed visual loss due to radiation retinopathy. Pak J Med Sci. 2016;32(2):516-8. doi: 10.12669/pjms.322.9221 pmid: 27182273
8. Parrozzani R, Midena E, Trainiti S, Londei D, Miglionico G, Annunziata T, et al. Identification and classification of macular morphologic biomarkers related to visual acuity in radiation maculopathy: A Multimodal Imaging Study. Retina. 2020;40(7):1419-1428. doi: 10.1097/IAE.0000000000002615 pmid: 31283736
9. Defendenti C, Atzeni F, Spina MF, Grosso S, Cereda A, Guercilena G, et al. Clinical and laboratory aspects of Ro/SSA-52 autoantibodies. Autoimmun Rev. 2011;10(3):150-4. doi: 10.1016/j.autrev.2010.09.005. Erratum in: Autoimmun Rev. 2012;11(9):685 pmid: 20854935
10. Hong KH, Chang SD. A case of radiation retinopathy of left eye after radiation therapy of right brain metastasis. Korean J Ophthalmol. 2009;23(2):114-7. doi: 10.3341/kjo.2009.23.2.114 pmid: 19568362
11. Finger PT, Kurli M. Laser photocoagulation for radiation retinopathy after ophthalmic plaque radiation therapy. Br J Ophthalmol. 2005;89(6):730-8. doi: 10.1136/bjo.2004.052159 pmid: 15923510
12. Horgan N, Shields CL, Mashayekhi A, Shields JA. Classification and treatment of radiation maculopathy. Curr Opin Ophthalmol. 2010;21(3):233-8. doi: 10.1097/ICU.0b013e3283386687 pmid: 20393294
13. Tan AC, Fleckenstein M, Schmitz-Valckenberg S, Holz FG. Clinical Application of Multicolor Imaging Technology. Ophthalmologica. 2016;236(1):8-18. doi: 10.1159/000446857 pmid: 27404384
14. Chik JYK, Leung CWL, Wong KH. Palliative radiation therapy for patients with orbital and ocular metastases. Ann Palliat Med. 2020;9(6):4458-4466. doi: 10.21037/apm.2019.12.02 pmid: 32156122
15. Serban D, Costea DO, Zgura A, Tudosie MS, Dascalu AM, Gangura GA, et al. Ocular Side Effects of Aromatase Inhibitor Endocrine Therapy in Breast Cancer - A Review. In Vivo. 2022;36(1):40-48. doi: 10.21873/invivo.12674 pmid: 34972698
16. Giuliari GP, Sadaka A, Hinkle DM, Simpson ER. Current treatments for radiation retinopathy. Acta Oncol. 2011;50(1):6-13. doi: 10.3109/0284186X.2010.500299 pmid: 20722590
17. Hurtikova K, Gerding H. Combined Laser Photocoagulation and anti-VEGF Injection Treatment in Radiation Retinopathy. Klin Monbl Augenheilkd. 2017;234(4):515-519. English. doi: 10.1055/s-0042-123165 pmid: 28282695
18. Ko FS, Sohn JH, Do DV. Resolution of macular edema in radiation retinopathy after intravenous diuresis. Retin Cases Brief Rep. 2010;4(2):174-7. doi: 10.1097/ICB.0b013e3181a59c31 pmid: 25390395
19. Russo A, Avitabile T, Uva M, Faro S, Franco L, Sanfilippo M, et al. Radiation Macular Edema after Ru-106 Plaque Brachytherapy for Choroidal Melanoma Resolved by an Intravitreal Dexamethasone 0.7-mg Implant. Case Rep Ophthalmol. 2012;3(1):71-6. doi: 10.1159/000337144 pmid: 22529805
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