Radiation retinopathy: a review

Area of Science:

• Ophthalmology
• Radiation Oncology
• Medical Imaging

Background:

• Radiation retinopathy (RR) and radiation maculopathy (RM) are significant vision-threatening complications following ocular and periocular radiotherapy.
• These conditions stem from progressive occlusive microangiopathy, leading to retinal ischemia, macular edema, and vision loss, particularly after uveal melanoma treatment.

Purpose of the Study:

• To understand the epidemiology, risk factors, and management of radiation retinopathy and maculopathy.
• To improve outcomes for patients undergoing ocular radiotherapy by addressing these complications.

Main Methods:

• Review of current literature on radiation retinopathy and maculopathy.
• Discussion of diagnostic advances, including OCT and OCT angiography.
• Evaluation of treatment strategies, focusing on anti-VEGF agents.

Main Results:

• RR and RM result from radiation-induced endothelial injury, leading to blood-retinal barrier breakdown and ischemia.
• Risk factors include patient comorbidities, tumor characteristics, and radiation parameters.
• Multimodal imaging allows early detection; anti-VEGF agents are the current standard for managing edema and preserving vision, though recurrence is common.

Conclusions:

• Radiation retinopathy and maculopathy remain significant challenges for visual preservation post-radiotherapy.
• Multimodal imaging and anti-VEGF therapy are crucial for diagnosis and management.
• Continued vigilance, timely treatment, and further research into novel therapeutics are essential for improving visual outcomes.