Rapid onset of radiation maculopathy after whole-brain radiation therapy: A case report.
BACKGROUND
Radiation maculopathy is a phenomenon that occurs after radiation exposure. The rapid onset of unilateral macular atrophy without peripheral retinopathy after radiation has rarely been described.


METHODS
A case report and literature review.


RESULTS
We report a case of stage 4 non-small cell lung cancer under targeted therapy using Gefitinib who presented with severely impaired visual acuity related to rapid onset of unilateral macular atrophy and diminished photoreceptor inner segment/outer segment (IS/OS) junction 1 month after whole-brain radiation therapy. The fundus fluorescein angiography revealed an enlarged diamond-shaped clear-cut foveal avascular zone in the macula without peripheral retinal vascular changes that differed from typical radiation retinopathy. We confirmed the diagnosis by evaluating the total radiation dosage and by excluding target therapy-induced maculopathy based on a review of the medical literature.


CONCLUSIONS
Current therapeutic interventions for macular atrophy after radiation therapy remain a challenge. Vasodilators or antiplatelet medication may be beneficial; however, long-term follow-up is needed. Further studies are required to support the use of early aggressive therapy for the prevention of radiation retinopathy.
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Cherng-Ru
CR
Hsu
Ming-Cheng
MC
Tai
Yun-Hsiang
YH
Chang
Ke-Hung
KH
Chien
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001921:Brain / Q000528:radiation effects; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology / Q000556:secondary; D016371:Cranial Irradiation / Q000009:adverse effects*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology; D008268:Macular Degeneration / Q000209:etiology* / Q000473:pathology; D008875:Middle Aged; D011799:Quinazolines / Q000627:therapeutic use; D011832:Radiation Injuries / Q000150:complications* / Q000473:pathology; D014792:Visual Acuity / Q000528:radiation effects
D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib
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