Radiation Maculopathy Treated with Ranibizumab

Abstract

Aim: Radiation maculopathy is a major cause of vision loss after brachytherapy or localized radiation treatments. Here, we describe a case report of a patient with bilateral radiation maculopathy and macular edema treated with ranibizumab and panretinal laser photocoagulation. Methods: Baseline fluorescein angiography and spectral domain OCT (SDOCT) was obtained. Eight-monthly intravitreous injections of ranibizumab 0.5 mg were performed in each eye. Snellen visual acuity, central subfield thickness (CST), total cube volume (TCV), cube average thickness (CAT) was recorded and a fundoscopic exam was performed at each visit. A final fluorescein angiography was obtained at the final visit. Results: After 8 treatments of ranibizumab 0.5 mg, Snellen visual acuity was 20/200 OD and 20/40 OS. The final CST was 392 µm OD and 495 µm OS, TCV was 13.4 mm3 OD and 11.1 mm3 OS, and CAT was 371 µm OD and 310 µm OS. Fundus photography and fluorescein angiography showed stabilization of radiation maculopathy OU but prominent macular ischemia OD. Conclusion: Vision loss from radiation maculopathy can be successfully treated with off-label ranibizumab in the short term. However, visual improvement is limited by macular ischemia, which had a larger effect on final visual acuity than reductions in CST, TCV, or CAT. Our study and others suggest that larger clinical trials to determine the dose, timing, and duration of ranibizumab treatment could benefit patients with radiation maculopathy.