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Radiation-induced maculopathy may respond better to dexamethasone

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COLORADO SPRINGS, Colo. — Recalcitrant radiation maculopathy after iodine-125 brachytherapy for uveal melanoma responded better to intravitreal dexamethasone rather than bevacizumab or triamcinolone, according to a scientific poster presented at the American Ophthalmological Society meeting here.

“Radiation maculopathy develops quite frequently following I-125 brachytherapy of uveal melanoma. Initial treatment with bevacizumab and/or triamcinolone is variably effective,” William F. Mieler, MD, FARVO, wrote in the poster. “Recalcitrant [cystoid macular edema] appears to respond quite readily to intravitreal dexamethasone and perhaps should be considered earlier in the treatment regimen of radiation-induced maculopathy.”

The retrospective study included 58 patients diagnosed with uveal melanoma. Patients underwent iodine-125 brachytherapy, with a mean dosage of 85.5 Gy, for an average of 152 hours. Patients were followed quarterly for an average of 32.1 months.

Radiation maculopathy developed in 23 patients (40%) an average 17.7 months after brachytherapy, depending on radiation dosage and proximity of the tumor to the macula.

Patients were first treated with intravitreal Avastin (bevacizumab, Genentech) sometimes alternated with triamcinolone. Average number of injections was 16.

Recalcitrant CME was identified in seven patients who were subsequently switched to Ozurdex (dexamethasone intravitreal implant, Allergan). CME resolved after one to two injections and stabilized for up to 1 year.

Visual acuity ranged from 20/25 to 20/400. “Visual results are quite variable, yet in select situations, excellent function can be obtained,” Mieler wrote.

Five of seven patients required cataract extraction. – by Matt Hasson and Patricia Nale, ELS

Reference:

Mieler WF. Intravitreal dexamethasone for recalcitrant CME following brachytherapy treatment of uveal melanoma. Presented at: American Ophthalmological Society meeting; May 19-22, 2016; Colorado Springs, Colo.

Disclosure: Mieler reports no relevant financial disclosures.