Current treatments for radiation retinopathy.
BACKGROUND
to review the currently available therapeutic modalities for radiation retinopathy (RR), including newer investigational interventions directed towards specific aspects of the pathophysiology of this refractory complication.


METHODS
a review of the literature encompassing the pathogenesis of RR and the current therapeutic modalities available was performed.


RESULTS
RR is a chronic and progressive condition that results from exposure to any source of radiation. It might be secondary to radiation treatment of intraocular tumors such as choroidal melanomas, retinoblastomas, and choroidal metastasis, or from unavoidable exposure to excessive radiation from the treatment of extraocular tumors like cephalic, nasopharyngeal, orbital, and paranasal malignancies. After the results of the Collaborative Ocular Melanoma Study, most of the choroidal melanomas are being treated with plaque brachytherapy increasing by that the incidence of this radiation complication. RR has been reported to occur in as many as 60% of eyes treated with plaque radiation, with higher rates associated with larger tumors. Initially, the condition manifests as a radiation vasculopathy clinically seen as microaneurysms and telangiectases, with posterior development of retinal hard exudates and hemorrhages, macular edema, neovascularization and tractional retinal detachment. Regrettably, the management of these eyes remains limited. Photodynamic therapy, laser photocoagulation, oral pentoxyphylline and hyperbaric oxygen have been attempted as treatment modalities with inconclusive results. Intravitreal injections of anti-vascular endothelial growth factor such as bevacizumab, ranibizumab and pegaptanib sodium have been recently used, also with variable results.


CONCLUSIONS
RR is a common vision threatening complication following radiation therapy. The available therapeutic options are limited and show unsatisfactory results. Further large investigative studies are required for developing better therapeutic as well as preventive treatment strategies.
Giuliari
Gian Paolo
GP
Princess Margaret Hospital, University of Toronto, Department of Ophthalmology and Vision Sciences, Hospital Health Network, Toronto, Ontario, Canada. gpgiuliari@gmail.com
Sadaka
Ama
A
Hinkle
David M
DM
Simpson
E Rand
ER
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000627:therapeutic use; D000068258:Bevacizumab; D001918:Brachytherapy / Q000009:adverse effects; D005134:Eye Neoplasms / Q000532:radiotherapy; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D017075:Laser Coagulation; D008028:Light Coagulation; D028022:Low-Level Light Therapy; D010431:Pentoxifylline / Q000627:therapeutic use; D010778:Photochemotherapy; D011832:Radiation Injuries / Q000209:etiology* / Q000628:therapy*; D000069579:Ranibizumab; D012160:Retina / Q000528:radiation effects*; D012164:Retinal Diseases / Q000209:etiology* / Q000628:therapy*; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D010431:Pentoxifylline; D000069579:Ranibizumab