Fran Lowry

May 29, 2012

May 29, 2012 (Fort Lauderdale, Florida) — Early diagnosis of radiation retinopathy with spectral domain optical coherence tomography (SD-OCT), followed by prompt treatment with intravitreal bevacizumab (Avastin, Genentech/Roche) injections, may prevent deterioration of vision in patients with uveal melanoma who have undergone plaque brachytherapy.

Researchers reported the finding here at the Association for Research in Vision and Ophthalmology (ARVO) 2012 Annual Meeting.

"Radiation retinopathy is a complication of plaque brachytherapy. Patients with uveal melanoma are treated with 125-iodine plaque brachytherapy for an average of 4 days and within 12 to 15 months, these patients begin to develop radiation retinopathy at the site of the radiation," lead author Nisha V. Shah, MD, from the Bascom Palmer Eye Institute, University of Miami, Florida, told Medscape Medical News.

Radiation retinopathy causes significant damage to the retina, leading to macular edema, which impairs vision. "We wanted to see if giving intravitreal injections of Avastin at 2- to 3-month intervals could beneficially affect visual acuity in these patients," Dr. Shah said.

She and her team retrospectively studied the records of 187 patients treated from 2007 to 2009 with plaque brachytherapy for posterior uveal melanoma. Of these patients, 110 (59%) developed radiation retinopathy.

The mean duration of follow-up after brachytherapy was 29 months. At the last follow-up visit, 52 of these patients (47%) had a visual acuity of 20/40 or better and were evaluated with SD-OCT every 2 to 3 months after plaque removal.

As soon as the first signs of radiation retinopathy and decreased best-corrected visual acuity (BCVA) were observed, the patients were treated with 2.5 mg/0.1 mL intravitreal bevacizumab . This was followed by repeat injections for recurrent or persistent vasculopathic changes.

The patients were given a mean of 4.1 injections (range, 1 - 17) during a mean of 17.8 months (range, 3 - 40 months), starting at 11.9 months after plaque brachytherapy.

In the eyes that maintained 20/40 or better vision at the last follow-up, pretreatment BCVA improved to 20/29, Dr. Shah reported.

In addition, mean foveal thickness was stabilized to 313 µm after a mean of 5.0 injections over the treatment period and the radiation retinopathy grade decreased from a mean of 3.3 to 1.9 (P < .0001), she said.

"Intravitreal [bevacizumab] is a somewhat controversial topic right now, but this study highlights that early treatment with anti-VEGF agents may stabilize the retinal vasculature and help these patients maintain or improve their visual outcomes," Dr. Shah said.

"I think the implications of our findings are phenomenal," she added. "Intravitreal bevacizumab definitely has a role to play in radiation retinopathy treatment."

Dr. Shah has disclosed no relevant financial relationships.

Association for Research in Vision and Ophthalmology (ARVO) 2012 Annual Meeting. Abstract # 3424. Presented May 8, 2012.


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