Radiation maculopathy after proton beam irradiation for choroidal melanoma.
OBJECTIVE
Radiation maculopathy is a microangiopathy of the retina, which is often observed after irradiation of the eye. To quantitatively determine the frequency of anatomic and functional features of this condition, the authors reviewed a large series of patients with choroidal melanomas who were treated by proton beam irradiation.


METHODS
Color photographs and/or fluorescein angiograms of 218 patients with paramacular choroidal melanomas were graded by two independent masked readers to determine the frequency of the various lesions of radiation maculopathy.


RESULTS
Overall, 194 (89%) of the 218 patients in this study developed some degree of radiation maculopathy. The earliest and most common finding was macular edema, which was observed in 87% of patients, overall, by the end of year 3. Microvascular changes (microaneurysms and/or telangiectasia), intraretinal hemorrhages, and capillary nonperfusion were noted in 76%, 70%, and 64% of eyes, respectively, by the end of postirradiation year 3. Visual acuity was retained at 20/200 or better in 90% of eyes 1 year after irradiation and in 67% of eyes 3 years after treatment.


CONCLUSIONS
Radiation maculopathy is common after proton beam irradiation of paramacular choroidal melanomas. However, ambulatory vision is preserved in many eyes.
Guyer
D R
DR
Retina Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114.
Mukai
S
S
Egan
K M
KM
Seddon
J M
JM
Walsh
S M
SM
Gragoudas
E S
ES
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002830:Choroid Neoplasms / Q000532:radiotherapy*; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D006801:Humans; D008266:Macula Lutea / Q000528:radiation effects*; D008297:Male; D008545:Melanoma / Q000532:radiotherapy*; D008875:Middle Aged; D010781:Photography; D011522:Protons; D011832:Radiation Injuries / Q000209:etiology*; D012164:Retinal Diseases / Q000209:etiology*; D012171:Retinal Vessels / Q000528:radiation effects; D014792:Visual Acuity / Q000528:radiation effects
D011522:Protons