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Anti‐ VEGF intravitreal injections in the management of radiation maculopathy – Against
Author(s) -
Papastefanou V.
Publication year - 2017
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2017.04116
Subject(s) - medicine , maculopathy , aflibercept , radiation therapy , dexamethasone , brachytherapy , triamcinolone acetonide , choroid , complication , ophthalmology , acetonide , bevacizumab , surgery , chemotherapy , retinopathy , retina , diabetes mellitus , endocrinology , physics , optics
Summary Radiation maculopathy (ischaemic or oedematous) is a dose‐dependent complication after radiation therapy associated with vascular decompensation caused by radiation damage. It develops primarily in patients treated for choroidal melanoma or other intraocular tumours following plaque brachytherapy or proton beam radiotherapy though it has been reported following epimacular brachytherapy for AMD patients or regional radiotherapy in other cases of malignant neoplasia. Though anti‐ VEGF treatment has been proposed in the management of radiation maculopathy there are inherent problems in its use. The pharmacokinetics of anti‐ VEGF necessitate repeated, and an increased number of intravitreal injections. The efficacy of anti‐ VEGF has been most robust when used preventively. Alternative treatments include macular laser, triamcinolone acetonide injections and more recently dexamethasone implants. The former had good anatomic results and the latter have comparable results with anti‐ VEGF agents in smaller series with less injections. Dexamethasone implants also had a more favourable outcome in cases non‐responsive to bevacizumab. Laser could still have an important preventive role especially in the treatment of ischemic areas.