Retinopathy after 30 Gray Whole Brain Radiation

Introduction

Radiation related retinopathy (RRP) is a progressive occlusive vascular disease leading to secondary retinal ischaemia. Typical clinical signs are microaneurysms, teleangiectatic vessels, cotton-wool areas, cystoid macular edema, hard exudates, occlusion of capillaries, hemorrhages, areas of ischemia, neovascularization, and potentially a serve deterioration of visual acuity [1]. The risk of radiation retinopathy is clearly related to radiation dose, fraction dose, preexisting vascular diseases and concomitant chemotherapy [2], [3], [4]. In the majority of cases RRP develops between 6 months and 3 years after radiation, but late manifestations with a delay of up to 20 years have been reported [2], [5]. In the case reported here, radiation related retinopathy was observed 6 years after whole-brain radiation therapy (WBRT) applying standard parameters of radiation which are generally regarded as safe.

^* Both Authors equally contributed to this publication.

• References

• 1 Amoaku WM, Archer DB. Fluorescein angiographic features, natural course and treatment of radiation retinopathy. Eye (Lond) 1990; 4: 657-667
• 2 Kaushik M, Pulido JS, Schild SE et al. Risk of radiation retinopathy in patients with orbital and ocular lymphoma. Int J Radiat Oncol Biol Phys 2012; 84: 1145-1150
• 3 Jeganathan VS, Wirth A, MacManus MP. Ocular risks from orbital and periorbital radiation therapy: A critical review. Int J Radiat Oncol Biol Phys 2011; 79: 650-659
• 4 Monroe AT, Bhandare N, Morris CG et al. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys 2005; 61: 856-864
• 5 Gupta A, Dhawahir-Scala F, Smith A et al. Radiation retinopathy: case report and review. BMC Ophthalmol 2007; 7: 6
• 6 Stallard H. Radiant energy as (a) a pathogenic (b) a therapeutic agent in ophthalmic disorders. Br J Ophthalmol 1933; 6: 1
• 7 Brown GC, Shields JA, Sanborn G et al. Radiation retinopathy. Ophthalmology 1982; 89: 1494-1501
• 8 Parsons T, Bova FJ, Fitzgerald CR et al. Radiation retinopathy after external-beam irradiation: Analysis of time-dose factors. Int J Radiat Oncol Biol Phys 1994; 30: 765-773
• 9 Minehan KJ, Martenson jr. JA, Garrity JA et al. Local control and complications after radiation therapy for primary orbital lymphoma: A case for low-dose treatment. Int J Radiat Oncol Biol Phys 1991; 20: 791-796
• 10 Stafford SL, Kozelsky TF, Garrity JA et al. Orbital lymphoma: Radiotherapy outcome and complications. Radiother Oncol 2001; 59: 139-144
• 11 Elsås T, Thorud E, Jetne V et al. Retinopathy after low dose irradiation for intracranial tumor of the frontal lobe. A case report. Acta Ophthalmol (Copenh) 1988; 66: 65-68
• 12 Grimm SA, Yahalom J, Abrey LE et al. Retinopathy in survivors of primary central nervous lymphoma. Neurology 2006; 67: 2060-2062
• 13 Karstens J, Bremer M, Meyer K et al. Strahlentherapie und Radioonkologie aus interdisziplinärer Sicht. Berlin: Lehmanns Media; 2005