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Case Reports and Small Case Series
January 1999

Good Visual Outcome Following Laser Therapy for Proliferative Radiation Retinopathy

Arch Ophthalmol. 1999;117(1):123-124. doi:

Radiation retinopathy is a potentially severe complication of radiation therapy for orbital disease. Findings range from intraretinal hemorrhages, cotton-wool spots, and macular edema (nonproliferative radiation retinopathy) to extensive retinal capillary ischemia leading to neovascularization and vitreous hemorrhage (proliferative radiation retinopathy). Kinyoun et al1 reported that eyes with proliferative radiation retinopathy had poor visual prognosis despite treatment with panretinal photocoagulation. We report a case of a man with proliferative radiation retinopathy treated with laser therapy who retained excellent vision for 5 years.

A 39-year-old man with a history of pineoblastoma had decreased vision in his left eye. The patient received 45 Gy of external beam irradiation in November 1992 (dose fraction, 1.8 Gy; 25 treatments in 36 days). Seventeen months later an examination revealed visual acuities of 20/25 OD and 20/40 OS, nonproliferative radiation retinopathy in the right eye, and neovascularization with vitreous hemorrhage and clinically significant macular edema confirmed by contact lens examination in the left eye. Fluorescein angiogram of the left eye demonstrated severe capillary nonperfusion and diffuse cystoid macular edema (Figure 1, A and B). The patient received grid laser treatment and panretinal photocoagulation in the left eye (Figure 1, C). He required a pars plana vitrectomy for nonclearing vitreous hemorrhage. Visual acuity improved to 20/25 OU with resolution of the macular edema and vitreous hemorrhage. The patient has had no recurrence of proliferative radiation retinopathy or macular edema in the left eye (Figure 2), and his visual acuity after cataract extraction 1 year later has remained stable at 20/20 OU for 3 years. A fluorescein angiogram performed 47 months after development of proliferative radiation retinopathy demonstrated intact foveal capillaries and no retinovascular leakage in the left eye. Early proliferative radiation retinopathy was present in the right eye.