Treatment of radiation-induced maculopathy with fluocinolone acetonide
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ONCOLOGY
Treatment of radiation-induced maculopathy with fluocinolone acetonide Lena Zimmermann 1
&
Christiane Kneifel 1 & Luise Grajewski 1 & Ilja F. Ciernik 2,3 & Lothar Krause 1
Received: 17 March 2020 / Revised: 4 May 2020 / Accepted: 13 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Chronic macular oedema is a well-known presentation of radiation-induced maculopathy (RM) following external beam photon therapy, plaque radiotherapy and proton beam radiotherapy for choroidal tumours. Current therapies vary in respect of efficacy and clinical benefit. The potential of fluocinolone acetonide (FAc) slow-release implants is unknown. We hypothesised that local continuous delivery of low-dose corticosteroids might improve symptoms of RM. Methods Five—two male and three female—patients from 37 to 68 years presented with RM following 106Ru-plaque brachytherapy or stereotactic radiation therapy (STx) with photons using a hypofractionated schedule of 5 × 10 Gy. All were treated with triamcinolone injections in first line and proofed to be refractory to steroids. In addition, two patients had received Ozurdex® implants as a second-line treatment, though without any clinical benefit. FAc slow-release implants were injected, and patients were followed up to monitor clinical improvement. Results All patients responded to therapy by means of a decrease in macular oedema. In four of five (80%) patients, visual acuity improved, and one patient showed stable visual acuity. No toxic effects or complications were observed. Conclusion Slow-release implants of FAc are a promising therapeutic potent steroid treatment option to benefit anatomical structures of the fovea and visual function. Slow-release implants with FAc reduce the frequency of intravitreal injections and the therapeutic burden. Keywords Radiation maculopathy . Iluvien® . Fluocinolone acetonide . Therapy development
Introduction Radiation maculopathy (RM) is a well-recognized complication in patients treated with plaque brachytherapy or external beam radiotherapy for choroidal melanomas. RM results in decreased visual acuity or even loss of vision. Ionizing radiation (IR) can cause vascular occlusion and proliferation of capillaries and small vessels, affecting the microvascular
* Lena Zimmermann [email protected] 1
Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Städtisches Klinikum Dessau, Klinik für Augenheilkunde, Auenweg 38, 06847 Dessau, Germany
2
Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Germany
3
University of Zürich, Zürich, Switzerland
architecture of the retina and the choroid [1]. The macular appears to be particularly susceptible to IR [1]. Both ischemia due to capillary occlusion and exudates can be observed. Retinal haemorrhage, lipid exudates and oedema formation impair visual acuity [5, 6, 10]. Effective therapy for t
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