First Author: N.Amine TUNISIA
Co Author(s): T. Rafak K. Sonda H. Firas F. Jamel
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Radiation maculopathy is associated with worse visual outcome. Several treatment modalities, such as laser photocoagulation or intravitreal injections, have already been tested. We report a case of better efficacy of steroid injection compared to anti-angiogenic injections for radiation maculopathy treatment.
52-year-old man was referred with history of a painless sudden visual loss in his right eye. He was submitted to external beam radiation cycles for rhinopaharynx carcinoma, five years ago. He was operated for traumatic cataract in the right eye, three years ago.
Best corrected visual acuity was counting fingers at 10 centimeters in the right eye and 10/10 in the left eye. Anterior segment was normal and intraocular pressure was within the normal limits in both eyes. Fundus examination showed a severe exsudative maculopathy associated with a posterior microangiopathy. The peripheric retina was normal. Fundus exam for left eye was normal. Fluorescein angiography showed posterial retinal ischaemia. SD-OCT showed severe cystoid macular edema (CME), in the right eye( macular thikness = 966 microm). The diagnosis of radiation maculopathy was established.
Due to the importance of CME, the patient was elected to three mensual intravitreal injections of bevacizumab (1.25mg/0.05 mL) in the right eye. One month later, visual acuity was not improved and macular thickness was slightly decreased (741 microm). We decided a triamcinolone acetonide (4 mg/1 mL) intravitreal injection. Three months later, visual acuity was improved to 1/10 and macular thikness was remarkably decreased (140 microm). Macular exudates decreased and there was no neovascularization of the retina nor iatrogenic ocular hypertonia.
Intravitreal steroids can be more efficients than anti-VEGF injection for severes exsudative radiation maculopathies. It stabilizes or improves visual acuity in such patients. Anti-VEGF injections seem more interesting for the prevention or the treatment of nevascualr complications of radiation retinopathy.