Five-Year Treatment Outcomes with 0.19 µg Fluocinolone Acetonide in Radiation-Induced Maculopathy

Chronic macular edema is a well-recognized complication of radiation-induced maculopathy (RM). Current treatment methods vary in efficacy and clinical benefit. The potential of fluocinolone acetonide (FAc) slow-release intravitreal implants (Iluvien® implant) remains unclear. We hypothesized that local continuous delivery of low-dose corticosteroids may improve RM symptoms.

This study included 8 patients who presented with RM after ¹⁰⁶-Ru-plaque brachytherapy (n = 3), proton beam therapy (n = 2), or stereotactic radiation therapy (n = 3) with photons. All eyes were initially treated with triamcinolone injections but proved refractory to steroids. The Iluvien® implant was injected, and patients were followed to monitor clinical improvement.

After 5 years, visual acuity improved in 3 patients, remained stable in 2 patients, and decreased in 2 patients. One patient progressed to no light perception following treatment. One patient was lost to follow-up after 5 years. Central macular thickness was reduced in 5 patients, stable in 1 patient, and increased in 1 patient.

Slow-release FAc implants are a promising treatment option to improve the anatomical structure of the fovea and visual function. They may also reduce the frequency of intravitreal injections and the overall therapeutic burden.