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Sean Platt, Diva Salomao, Jose Pulido; Histologic Findings of Choroidal Vasculopathy in Eyes Enucleated Following Radiation Therapy for Uveal Melanoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4298.
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Little has been written about the choroidal vascular remodeling that occurs years after radiation exposure. We hypothesize that the sequelae of choroidal radiation damage are partly related to choroidal remodeling resulting in polypoidal vasculopathy and choroidal neovascularization. We wanted to histologically explore the choroidal vascular changes following radiotherapy for uveal melanoma.
Records from patients that underwent an enucleation from a single institution were retrospectively reviewed from June 7th, 2007 to June 7th, 2017. 103 patients that had an enucleation with a diagnosis of uveal melanoma that underwent radiotherapy had their records reviewed. 30 patients/eyes were later enucleated after radiotherapy. Of these 30 eyes, 18 were enucleated after complications related to radiation exposure. A histopathologic analysis was conducted on all 18 eyes enucleated for radiation complications with special emphasis on the choroidal changes.
Of the 18 enucleation specimens that underwent histopathologic analysis, 10 (56%) were female and 8 (44%) were male. Mean age was 65 years. Mean time from radiation exposure to enucleation was 7.2 years. Clinically prior to enucleation, 9 eyes (50%) had evidence of vitreous hemorrhage, 8 eyes (44%) had evidence of radiation retinopathy, and 5 eyes (28%) had evidence of choroidal vasculopathy. Pathological evidence of choroidal vasculopathy was revealed in 13 eyes (72%). Of these 13 eyes, 4 eyes (31%) had ectatic vascular remodeling consistent with choroidal polypoidal vasculopathy, 1 eye (8%) had only hyalinization of choroidal vessels, and 8 eyes (62%) had evidence of both.
Our results show choroidal vasculopathy was a common histologic feature associated with the long-term effects of radiation exposure. Radiation causes not only radiation retinopathy but also radiation choroidopathy. The role of radiation choroidopathy in the subsequent visual loss following radiotherapy and the role of anti-VEGF therapy to treat it needs to be recognized and distinguished from radiation retinopathy.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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