Intravitreal Aflibercept for the Treatment of Radiation-induced Macular Edema after Ruthenium 106 Plaque Radiotherapy for Choroidal Melanoma

Graefe's Archive for Clinical and Experimental Ophthalmology
15 May, 2019 ,

Matteo Fallico et al evaluated intravitreal aflibercept for its efficacy on best-corrected visual acuity, central foveal thickness detected by spectral domain optical coherence tomography, and Horgan’s grading scale of RM. They included 9 eyes of 9 patients. As per outcomes, intravitreal aflibercept led to functional and anatomical improvements in these patients with a relatively low number of injections.

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Abstract

Purpose

To assess the efficacy of intravitreal aflibercept in patients suffering from post-radiation macular edema following plaque radiotherapy for choroidal melanoma.

Methods

This prospective, interventional case series included patients affected by radiation maculopathy (RM) with macular edema secondary to ruthenium-106 plaque brachytherapy for choroidal melanoma. The effect of intravitreal aflibercept on best-corrected visual acuity (BCVA), central foveal thickness (CFT) detected by spectral domain optical coherence tomography (sd-OCT), and Horgan’s grading scale of RM was evaluated throughout the 24-month follow-up. Intraocular pressure (IOP) and possible complications were also recorded.

Results

Nine eyes of 9 patients were included. A mean of 4.4 ± 1.2 injections were given over the 24 months. At the end of follow-up, mean BCVA was significantly improved, from 0.9 ± 0.19 logMAR at baseline to 0.56 ± 0.3 logMAR (P = 0.028), and mean CFT was significantly decreased, from 546 ± 123 μm at baseline to 223 ± 34 μm (P < 0.001). Intravitreal aflibercept lowered baseline maculopathy stage as well. No significant change in IOP values and no complications, such as endophthalmitis, was recorded.

Conclusion

Intravitreal aflibercept is an effective treatment for patients with radiation-induced macular edema, allowing functional and anatomical improvements to be achieved with a relatively low number of injections.