Proliferative radiation retinopathy

To compare proliferative radiation retinopathy (PRR) with nonproliferative radiation retinopathy (NPRR) and to assess the outcome of panretinal photocoagulation treatment for PRR.

We reviewed the medical records, fundus photographs, and fluorescein angiograms of 10 patients (14 eyes) with PRR, which was diagnosed in a tertiary referral center during a 20-year period. The collected data included the following: the indications for radiation treatment, radiotherapy technique used, dose and fractions of radiation, visual acuity, indications for photocoagulation treatment, photocoagulation technique used, and response to treatment. Comparisons were made with data from 17 patients (27 eyes) with NPRR, which had not progressed to PRR during the course of this study.

The initial visual acuity of the 14 eyes with PRR ranged from 20/20 to hand motion; these eyes had a median visual acuity of 20/90. The initial visual acuity of the 27 eyes with NPRR ranged from 20/15 to 20/400; these eyes had a median visual acuity of 20/25. Five (36%) of the eyes with PRR and 4 (15%) of the eyes with NPRR (P = .35) had a visual acuity of 20/200 or worse. After a mean follow-up time of 75 months for the eyes with PRR and 51 months for the eyes with NPRR, the median visual acuities were 20/400 and 20/50, respectively; 12 (86%) of the 14 eyes with PRR had a visual acuity of 20/200 or worse vs 7 (26%) of the 27 eyes with NPRR (P < .007). The new vessels had resolved in 10 (91%) of the 11 eyes that were treated with panretinal photocoagulation for PRR.

Eyes with PRR have a poor prognosis for retaining and regaining good central vision. Panretinal photocoagulation seems to have long-term effectiveness in decreasing the proliferation of new vessels due to complications of radiation treatment.