Intravitreal anti-VEGF therapy has limited benefit in treating radiation retinopathy following iodine-125 radiotherapy for the treatment of choroidal melanoma

Abstract

Purpose: Although the use of anti-vascular endothelial growth factor (VEGF) inhibitors has emerged as a common treatment for radiation macular edema following plaque radiotherapy for choroidal melanoma, studies evaluating long-term protective benefits of bevacizumab in vision and macular edema are limited. We performed a retrospective consecutive review to elucidate the outcomes and efficacy duration of the intravitreal anti-VEGF agent bevacizumab in patients who developed radiation retinopathy following iodine-125 brachytherapy for local treatment of choroidal melanoma.

Methods: All patients at the Ophthalmic Oncology Center at the Stein Eye Institute who received at least one intravitreal anti-VEGF in the form of bevacizumab, for the treatment of radiation retinopathy evidenced by macular edema following iodine-125 brachytherapy for the treatment of choroidal melanoma from 2001-2013 were included. Patient and baseline tumor characteristics were recorded; treatment response was evaluated by reviewing best recorded Snellen visual acuity (BRVA) and foveal thickness measured by spectral domain optical coherence tomography (SD-OCT).

Results: Forty-two patients received bevacizumab injection initiated at a mean of 38 months (range 3-310) following iodine-125 brachytherapy with a mean of 5 injections (range 1-18) over 8 months with mean follow-up time of 19 months (range 1-66) following first injection. BRVA at final follow-up was 20/215, a statistically significant decline from a pre-injection baseline of 20/76 (p=0.0056). BRVA at one month was 20/74, not statistically different from baseline (p=0.9348). Baseline mean SD-OCT foveal thickness was 440 mm. No differences in foveal thickness were found at one month or final follow-up, with mean foveal thicknesses of 382 mm (p=0.1180) and 387 mm (p=0.1535), respectively.

Conclusions: Bevacizumab may not improve visual acuity nor SD-OCT foveal thickness in patients who develop radiation retinopathy with macular edema. Any benefits of anti-VEGF therapy with bevacizumab appear to not be sustained.