Radiation-induced maculopathy and fluocinolone acetonide implant

This study evaluates the effectiveness of fluocinolone acetonide (FAc) implants in managing radiation maculopathy, a complication of ocular irradiation. The primary outcomes were the change in best-corrected visual acuity (BCVA) and central foveal thickness (CFT), and the impact on therapeutic burden and intraocular pressure (IOP).

This was a retrospective, multicenter, observational study conducted across three French oncology-ophthalmology reference centers. Twelve eyes of twelve patients with radiation maculopathy following ocular irradiation for uveal melanoma were included. All patients received at least one injection of the FAc implant between February 2021 and July 2023. Data on tumor characteristics, lens status, BCVA, CFT, IOP, and SD-OCT findings were collected. The number and types of intravitreal injections before and after FAc implantation were analyzed.

Median final BCVA improved significantly to 72.5 ETDRS letters (IQR 57.5-76.2) (Snellen equivalent: 20/32) (p = 0.03). Median final CFT decreased significantly to 328.0 μm (IQR 286.0-405.0) (p = 0.04). The therapeutic burden was significantly reduced, with the mean injection interval increasing from 4.2 to 6.5 months (p = 0.03) and the annual number of injections decreasing from 3.2 to 0.2 (p < 0.001). IOP significantly increased during follow-up, peaking at 21.5 mmHg (IQR 18-25) (p < 0.001) but returned to the baseline of 13 mmHg after the treatment adjustments made at the final visit (IQR 11.5-17.2) (p = 0.20).

FAc implant improved BCVA and significantly reduced the therapeutic burden in patients with radiation maculopathy. However, careful IOP monitoring is required to effectively manage intraocular hypertension.