Abstract
Purpose :
Radiation-induced injury to ocular structures is a common iatrogenic consequence of radiotherapy for uveal melanoma. Radiation retinopathy is a dose-dependent complication of the retina following exposure to ionizing radiation. To the best of our knowledge, this is the first series describing the outcomes of patients treated with monthly aflibercept for radiation maculopathy who have failed monthly bevacizumab. Failure is defined as incomplete resolution of fluid despite monthly injections for 6 months or complete resolution of fluid with monthly injections, but an inability to extend beyond a 1-month interval between treatment. Clinically significant improvement is defined as an improvement of 1 line of visual acuity on an Early Treatment Diabetic Retinopathy Study chart or reduction in sub-retinal fluid of 100 microns. It is hypothesized that a portion of patients who failed bevacizumab will respond with a clinically significant difference with aflibercept.
Methods :
A prospective case-series of patients with clinically significant radiation maculopathy were enrolled. The currently utilized clinical treatment algorithm of primary bevacizumab followed by aflibercept for failed cases was employed. Standardized testing, as part of the Alberta Ocular Brachytherapy program, was performed on all patients at two sites in Alberta, Canada. Visual and retinal response to therapy was assessed with regression analyses.
Results :
Thirty patients, 17 female and 13 male, with a mean age of 57 years (± 15) underwent the switch from monthly intravitreal bevacizumab treatment to intravitreal aflibercept. The primary endpoints were central foveal thickness (CFT) and visual acuity (VA) at one month, three months, and six months following the switch to aflibercept. Regression analysis showed statistically significant differences between bevacizumab and treatment by aflibercept at one month (P=0.003, P=0.02), three months (P=0.004, P=0.004), and six months (P=0.003, P=0.013) in both CFT and BCVA, respectively. Fourteen patients showed a clinically significant improvement in CFT and seven patients showed a clinically significant VA improvement following six months of aflibercept.
Conclusions :
This pilot study suggests that a portion of patients who have failed monthly bevacizumab may respond to aflibercept. A larger series would be beneficial in quantifying this response.
This is a 2021 ARVO Annual Meeting abstract.