Radiation retinopathy

Signs and symptoms

Clinically, affected people may not have symptoms or may complain of decreased visual acuity. Ophthalmic examination may reveal signs of retinal vascular disease, including cotton-wool spots, retinal bleeds, microaneurysms, perivascular sheathing, capillary telangiectasis, macular edema, and disc edema. Capillary non perfusion, documented by fluorescein angiography, is commonly present, and extensive retinal ischemia can lead to neovascularization of the retina, iris, and disc. Staging of radiation retinopathy has been proposed.

Pathophysiology

Radiation retinopathy is very similar to other vascular diseases. Diabetes and radiation primarily damage the retinal capillaries. Diabetes results in early loss of pericytes and thickening of the basement membrane. Radiation however, damages the endothelial cells.

Treatment

The management of radiation retinopathy is similar to that for diabetic retinopathy and includes focal laser therapy to reduce macular edema or panretinal photocoagulation to treat zones of ischemia and neovascularization. Anti-vascular endothelial growth factors have been recently used for the treatment of radiation retinopathy. Monitoring of visual acuity in all cases and early referral to the ophthalmologist is warranted.

References

References

1. American Academy of Ophthalmology. (2012). "Retina and vitreous". American Academy of Ophthalmology.
2. Gupta, Abha. (1 January 2007). "Radiation Retinopathy: Case report and review". BMC Ophthalmology.
3. Finger, PT. (Jul–Aug 2011). "Intravitreal anti-VEGF bevacizumab (Avastin) for external beam related radiation retinopathy.". European Journal of Ophthalmology.
4. Finger, PT. (Jun 2005). "Laser photocoagulation for radiation retinopathy after ophthalmic plaque radiation therapy.". The British Journal of Ophthalmology.