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Nikisha Kothari, Tara McCannel; Intravitreal Aflibercept for Radiation Retinopathy After Iodine-125 Brachytherapy for the Treatment of Choroidal Melanoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4304.
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The use of anti-vascular endothelial growth factor (VEGF) agents for macular edema secondary to radiation from plaque radiotherapy has become a mainstay of treatment. We performed a retrospective, observational clinical study to learn about the structural and visual acuity outcomes in a long-term cohort to study the role of aflibercept in radiation macular edema.
We analyzed 27 consecutive patients from University of California, Los Angeles who received aflibercept for radiation retinopathy, specifically macular edema following iodine-125 brachytherapy for choroidal melanoma. Treatment response was evaluated by reviewing best corrected visual acuity (BCVA) and foveal thickness measured by spectral domain optical coherence tomography (SD-OCT).
Twenty-seven patients received aflibercept injections initiated following development of macular edema secondary to radiation with mean of 8.4 injections (range 1-34) with a mean follow up of 21 months (1-43) following first injection with aflibercept. BCVA at final follow up was 20/155, a statistically significant decline from 20/77 at baseline (p=0.0106). BCVA at one month 20/84 was not statistically significant from baseline (p=0.3805). Baseline mean central subfield thickness was 426 microns. There was improvement in central thickness at one month and final follow-up, with a mean foveal thickness of 399 microns (p=0.1123) and 419 microns (p=0.8609), respectively, though not statistically significant. 30% (8/27) of patients had stable or improved vision from their baseline visual acuity. 48% (13/27) of patients had a final visual acuity of 20/60 or better.
Aflibercept may not improve visual acuity nor significantly improve SD-OCT foveal thickness in patients who have development symptomatic radiation retinopathy. However, aflibercept may help maintain vision in a small cohort of patients.
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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