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CC BY-NC-ND 4.0 · Klin Monbl Augenheilkd 2024; 241(04): 459-462
DOI: 10.1055/a-2276-6309
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Persistent and Poor-Responsive Cystoid Macular Edema after Stereotactic Radiotherapy in Neovascular Age-Related Macular Degeneration: A Case Report of Three Patients

Persistierendes und schlecht ansprechendes zystoides Makulaödem nach stereotaktischer Strahlentherapie bei neovaskulärer altersabhängiger Makuladegeneration: ein Fallbericht von 3 Patienten
Filippo Billia 
1   Ophthalmology, Vista Augenklinik Binningen, Switzerland
2   Ophthalmology, Avanti Clinica Oculistica, Lugano, Switzerland
,
Katja Hatz-Wurziger
1   Ophthalmology, Vista Augenklinik Binningen, Switzerland
3   Ophthalmology, Faculty of Medicine, University of Basel, Switzerland
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Background

Low-Dose stereotactic radiotherapy (SRT) is an adjuvant therapy for wet AMD, proved to reduce anti-VEGF treatment frequency [1], [2]. SRT provides stereotactic application of low-energy X-ray radiation to the retina, through a device capable to deliver radiation over a 4-mm treatment zone in a single treatment session [3].SRT radiations attenuate the inflammatory response that is believed to play an important role in choroidal neovascularization (CNV) reactivation. They can also reduce scar formation by inhibiting fibroblasts and lead to the death of rapidly dividing endothelial cells, the main pathological component of CNV complexes [3]. SRT treatment, although still an experimental treatment, is known to be a safe and efficient procedure, but some long-term side effects are known. Radiation retinopathy (RR) is the most dreaded long-term complication of radiotherapy to the eye but because the SRT device delivers precisely targeted radiotherapy, and as the area of retinal exposure is extremely small a larger area of RR is not expected to develop [4], [5], [6].

However, microvascular abnormalities (MVAs) are a sign of ionizing radiation damage, with an incidence of 36% in patients treated with SRT at 2 years [4], [5], [6]. Retinal MVA found in color fundus photography, fluorescein angiography and/or A-OCT included nerve fibre infarcts, retinal haemorrhages, microaneurysms, luminal irregularities, focal areas of capillary closure, distended (bullous) arteriolar and venular tips, telangiectatic segments, and late staining of the vessel walls [4], [5]. Here, we present three typical cases with initial good response to SRT including reduction of injection frequency but developing a persistent and poorly responsive cystoid macular edema.



Publication History

Received: 25 October 2023

Accepted: 14 November 2023

Article published online:
23 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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