Neuroinflammation in Radiation Maculopathy: A Pathophysiologic and Imaging Perspective
Giulia Midena1, Raffaele Parrozzani2, Marisa Bruno1
1IRCCS-Fondazione Bietti, 00198 Rome, Italy.
Background:
Radiation maculopathy (RM) is a delayed, sight-threatening complication of ocular radiotherapy. Traditionally regarded as a pure microvascular disease, emerging evidence points to the central role played by retinal neuroinflammation, driven by microglial activation and cytokine dysregulation affecting both the retina and the choroid. Hyperreflective retinal foci, neuroinflammatory in origin (I-HRF), visualized through advanced imaging modalities such as spectral domain optical coherence tomography (OCT), have been identified as early and critical biomarkers of both preclinical and clinical retinal neuroinflammation.
Materials And Methods:
This review synthesizes findings from experimental and clinical studies to explore the pathophysiology of neuroinflammation and the associated imaging parameters in RM.
Results:
The integration of experimental and clinical evidence specifically underscores the significance of I-HRF as an early indicator of neuroinflammation in RM. OCT enables the identification and quantification of these biomarkers, which are linked to microglial activation and cytokine dysregulation.
Conclusions:
The pathophysiology of RM has evolved from a predominantly vascular condition to one strongly secondary to neuroinflammatory mechanisms involving the retina and choroid. In particular, I-HRF, as early biomarkers, offers the potential for preclinical diagnosis and therapeutic intervention, paving the way for improved management of this sight-threatening complication.
Insights
Radiation maculopathy (RM) is now understood to be driven by neuroinflammation, not just vascular issues. Neuroinflammatory hyperreflective foci (I-HRF) detected by OCT are early biomarkers for preclinical diagnosis and treatment.
Area of Science:
- Ophthalmology
- Neuroscience
- Radiology
Background:
- Radiation maculopathy (RM) is a severe complication of ocular radiotherapy.
- Emerging evidence highlights neuroinflammation, involving microglial activation and cytokine dysregulation, as central to RM pathogenesis.
- Hyperreflective retinal foci of neuroinflammatory origin (I-HRF) are critical early biomarkers.
Purpose of the Study:
- To review the pathophysiology of neuroinflammation in RM.
- To explore associated imaging parameters, particularly I-HRF.
- To synthesize experimental and clinical findings on RM biomarkers.
Main Methods:
- Literature review of experimental and clinical studies.
- Synthesis of data on neuroinflammation in RM.
- Focus on optical coherence tomography (OCT) for imaging biomarkers.
Main Results:
- I-HRF are significant early indicators of neuroinflammation in RM.
- OCT facilitates the identification and quantification of I-HRF.
- These biomarkers correlate with microglial activation and cytokine changes.
Conclusions:
- RM pathophysiology is shifting from a vascular to a neuroinflammatory paradigm.
- I-HRF serve as crucial early biomarkers for RM.
- I-HRF enable potential preclinical diagnosis and therapeutic strategies for RM.
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