Recurrent Radiation Retinopathy and Optic Neuropathy after Cranial Irradiation Therapy Treated by Intravitreal Bevacizumab

Abstract

Purpose: To report a case of radiation retinopathy and optic neuropathy after head irradiation therapy treated by intravitreal triamcinolone and bevacizumab Methods: Case report. Case: A 38 year old woman presented with visual acuity impairment. She received cranial radiation therapy (dose: 35Gy) for brain metastasis 1 year ago. The best-corrected visual acuity (BCVA) was 16/20 in the right and 4/20 in the left eye. Fundus examination showed hard exudate, retinal hemorrhage, and macular edema in both eyes. Triamcinolone acetonide was injected into the vitreous of both eyes. BCVA improved to 20/20 in the right and 12/20 in the left eye after 4 weeks. Both eyes showed recurrence of macular edema 3 months after the injection. BCVA was 2/20 in the right and 6/20 in the left eye.  Fundus examination showed retinal exudation and hemorrhage around the optic nerve and blurring of the optic nerve head borders was established. Three scheduled monthly injections of Bevacizumab were administered intravitrealy. After 3 injection, BCVA was 16/20 and 18/20 in her right and left eyes respectively. Conclusion: Intravitreal bevacizumab was well tolerated, improved vision, and reduced retinal edema. No ocular or systemic side effects were noted.