Pediatric Radiation Retinopathy: Impact of Early Diagnosis and Targeted Treatment

Purpose: To evaluate the impact of spectral-domain optical coherence tomography (SD-OCT) evaluation for maculopathy in eyes with retinoblastoma treated with external beam radiation coupled with targeted intravitreal antivascular endothelial growth factor (bevacizumab) on the treatment of radiation retinopathy. Methods: This is an institutional review board-approved, retrospective analysis of a consecutive case series of eyes with post-external beam radiation regressed retinoblastoma developing SD-OCT-confirmed retinopathy and documented visual decline. All patients were treated with external beam radiotherapy (40-50 Gy in 1.8-2.0 Gy fractions) prior to inclusion. Intravitreal bevacizumab 1.25 mg was injected in all eyes that met the inclusion criteria. All patients were treated with a primary treat-and-adjust schedule focused initially on a 6-week interval. Results: Nineteen subjects (11 male, 8 female) were included, with a mean follow-up of 40 months (range, 30-66 months). A total of 30 eyes met the inclusion criteria. After treatment, the mean SD-OCT central subfield foveal thickness of the entire cohort decreased from 511 μm at baseline to 389 μm by month 2, and 263 μm by year 2. Mean cohort intravitreal injections of bevacizumab totaled 8.2 during the first year, 7.6 during the third year, and 5.9 during the fifth year. Conclusions: This study offers new medical evidence suggesting that early diagnosis and antivascular endothelial growth factor therapy may improve visual outcomes in pediatric radiation retinopathy. Intravitreal bevacizumab improved visual acuity and anatomy in pediatric eyes with stable retinoblastoma and radiation maculopathy.