Radiation Retinopathy After Whole-Brain Radiotherapy in a Patient With Pineal Gland Tumor

Purpose: To describe a case of radiation retinopathy following craniospinal radiation and provide an overview of studies on radiation retinopathy following whole-brain radiotherapy. Methods: A retrospective chart review was conducted to collect a single patient's data on demographics, radiation therapy, ophthalmologic examination findings, treatment, and outcomes. For the systematic review, OVID Medline, Embase, and Cochrane CENTRAL were searched for studies reporting on radiation retinopathy following whole-brain radiotherapy. Results: A 24-year-old man with a history of craniospinal radiation presented with proliferative maculopathy. Initial visual acuity was 20/150 in the right eye and 20/40 in the left eye. The patient received monthly intravitreal injections of bevacizumab followed by panretinal laser photocoagulation in both eyes. Maculopathy improved following treatment. Nine articles comprising 13 cases of radiation retinopathy following whole-brain radiotherapy (25 affected eyes; mean ± SD age, 43.3 ± 10.8 years; 46.2% male) were identified by systematic review. None of the patients had diabetes. Radiotherapy was indicated for primary central nervous system lymphoma (6 cases), metastatic spread of breast cancer (4 cases) or lung cancer (2 cases), and acute lymphocytic lymphoma (1 case). The median radiation dose received was 40.7 Gy (range, 30-50). Ten patients had received prior or concurrent chemotherapy. Median time from radiotherapy to symptom onset was 20.5 months (range, 2-216). More than half of patients developed retinopathy bilaterally. Conclusions: To our knowledge, this is the first systematic review to highlight the risk of radiation retinopathy following whole-brain radiotherapy, particularly the increased frequency in patients who have received chemotherapy.