CASE REPORT

A 32-year-old male visited an eye hospital with a complaint of decreased vision in his right eye. On history taking, he revealed that he had a Myxofibrosarcoma of the right zygomatic bone and was treated with radiation therapy for that tumor.

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Radiation Retinopathy

Visual acuity noted was: OD= 6/24, OS= 6/6. On Fundus examination, macular edema, cotton wool spots, and retinal hemorrhages were noted.

Based on history taking and fundus findings, the patient was diagnosed with radiation retinopathy and was given intravitreal bevacizumab as an option of treatment and kept on monthly follow-up.

Visual ups and downs were noted in his follow-up duration and administration of multiple intravitreal injections was made sure from time to time to notice any improvement in visual acuity.

DISEASE

Radiation Retinopathy is a complicated condition in which the retina is damaged due to exposure to any source of radiation used in the treatment of ocular cancers.

This source of radiation can be either an external beam(which is used in the treatment of nasopharyngeal, paranasal sinuses, and orbital tumors) or plaque brachytherapy (which is used in the treatment of Intraocular tumors).

It was first discovered by Stallard in 1933 and it does not have an acute onset, instead affects after months or years of radiation exposure.

People who are diabetic, hypertensive, those undergoing chemotherapy, and pregnant women are at increased risk of radiation retinopathy.

Radiation Retinopathy

In the early stage of radiation retinopathy, most people are asymptomatic but as the disease progresses, patients may complain of decreased vision and floaters.

Its clinical manifestations are documented as microaneurysms, retinal hemorrhages, cotton wool spots, macular edema, telangiectases, disc edema, perivascular sheathing, capillary non-perfusion, retinal ischemia leading to neovascularization of retina, disc, and iris.

MANAGEMENT

The management plan includes primary prevention of ocular structures by shielding them during exposure to external beam radiation.

When applying plaque brachytherapy, efforts are made to reduce the dose of radiation by either use of collimating plaques or adjusting the position of plaques eccentrically.

Radiation Retinopathy

Treatment :

Medical Treatment :

  • Vascular endothelial growth factors (VEGF) are now in use to treat radiation retinopathy. Some of the VEGF can be mentioned as:

* Intravitreal Bevacizumab temporarily stops the progression of radiation retinopathy. But for long-lasting effects administration of multiple injections is required. It does not improve vision significantly but can prevent further worsening of vision.

* Intravitreal Triamcinolone acetonide is given to treat macular edema.

  • Focal laser therapy is done to treat macular edema
  • Panretinal photocoagulation is also done to treat regions of ischemia and neovascularization.

Surgical:

Pars plana Vitrectomy(PPV) is done in case of proliferative radiation retinopathy associated with vitreous hemorrhage and tractional retinal detachment.

Would you have interest in taking retina images by smartphone?

Fundus photography is superior to fundus analysis as it enables intraocular pathologies to be photo-captured and encrypted information to be shared with colleagues and patients.

Recent technologies allow smartphone-based attachments and integrated lens adaptors to transform the smartphone into a portable fundus camera and Retinal imaging by smartphone.

RETINAL IMAGING BY YOUR SMARTPHONE

REFERENCES

  1. Finger PT, Chin KJ, Duvall G, Palladium-103 for Choroidal Melanoma Study Group. Palladium-103 ophthalmic plaque radiation therapy for choroidal melanoma: 400 treated patients. Ophthalmology. 2009;116(4):790–6. e1. doi: 10.1016/j.ophtha.2008.12.027.
  2. Wara WM, Irvine AR, Neger RE, Howes EL, Jr, Phillips TL. Radiation retinopathy. Int J Radiat Oncol Biol Phys. 1979 Jan;5(1):81–83.
  3. Finger PT. Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects. Surv Ophthalmol. 2009;54(5):545–568.
  5. Hayreh SS. Post-radiation retinopathy. A fluorescence fundus angiographic study. Br J Ophthalmol. 1970 Nov;54(11):705–714.
  6. Noble KG, Kupersmith MJ. Retinal vascular remodelling in radiation retinopathy. Br J Ophthalmol. 1984 Jul;68(7):475–478.
  7. Gass JD. A fluorescein angiographic study of macular dysfunction secondary to retinal vascular disease. VI. X-ray irradiation, carotid artery occlusion, collagen vascular disease, and vitritis. Arch Ophthalmol. 1968 Nov;80(5):606–617.

RETINAL IMAGING BY YOUR SMARTPHONE

RETINAL IMAGING BY YOUR SMARTPHONE

RETINAL IMAGING BY YOUR SMARTPHONE

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