[Radiotherapy for age-related macular degeneration: risk factors of complications, prevention and treatment of side-effects].
OBJECTIVE
To analyze the retinal and choroidal side-effects of radiotherapy given for age-related macular degeneration (ARMD) and to describe the risk factors of these complications and their treatment.


METHODS
and methods: Two hundred and ninety five eyes in 270 patients with ARMD were treated using radiotherapy. Nineteen patients had diabetes. The doses were as follows: 15 Gy or less (4 eyes); 16 Gy/4 fractions (113 eyes); 18 Gy/5 fractions (35 eyes); 20 Gy/5 fractions (123 eyes); 24 Gy/6 fractions (2 eyes); 28.8 Gy/8 fractions (17 eyes); more than 28.8 Gy (1 eye). Patients had a regular follow-up visit with visual acuity, contrast sensitivity evaluation, biomicroscopic fundus examination, fluorescein and ICG angiographies every six months over a mean period of 15 months.


RESULTS
Radiation retinopathy was noted in 15 eyes, a bilateral neovascular glaucoma in one patient, ischemic optic neuropathy in 5 eyes, choroidal telangiectasiae in 19 eyes, venous occlusion in 2 eyes, oedematous retinopathy with major exudation (ORME) in 31 eyes, and choroidal hematoma in 8 eyes. Radiation retinopathy, choroidal telangiectasiae and ORME were related to radiation dose. Radiation retinopathy was more severe and more frequent in patients with diabetes. Choroidal telangiectasiae were diagnosed with ICG angiography and were treated early with laser.


CONCLUSIONS
Radiotherapy for ARMD should not be done in patients with diabetes. Hypofractionation is not recommended. ICG angiography should be considered essential in the follow-up of patients treated with radiotherapy.
Mauget-Faÿsse
M
M
Centre d'Imagerie Laser, 14, rue Rabelais, 69003 Lyon. mm411-1@dial.oleane.com
Coquard
R
R
Français-Maury
C
C
Milea
D
D
Chiquet
C
C
Martin
P
P
Romestaing
P
P
Romanet
J P
JP
Gérard
J P
JP
D000368:Aged; D002829:Choroid / Q000528:radiation effects*; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000532:radiotherapy*; D008297:Male; D009900:Optic Nerve / Q000528:radiation effects*; D011832:Radiation Injuries / Q000209:etiology* / Q000628:therapy; D011879:Radiotherapy Dosage; D012160:Retina / Q000528:radiation effects*; D012307:Risk Factors; D016896:Treatment Outcome