Radiation Retinopathy 47 Years following Brachytherapy for Retinoblastoma

A 50-year-old female who had undergone enucleation in the left eye and brachytherapy in the right eye for retinoblastoma at the age of 2 years was diagnosed with nonproliferation radiation retinopathy 47 years following the initial treatment. The patient had noticed black spots in her vision (scotomas) that interfered with reading. New onset of microaneurysms and lipid exudation threatening the foveola was noted on examination of the right eye. Initial visual acuity (VA) was 20/25. Optical coherence tomography showed no evidence of macular edema, but parafoveal lipid exudation was present. On fluorescein angiography, no sign of neovascularization or macular ischemia was observed. Direct focal treatment of microaneurysms was performed to prevent progression of the radiation retinopathy and vision loss. At 18 months' follow-up following focal laser, VA remained stable at 20/25 and there was a regression of the retinopathy.