Korean J Ophthalmol.  2009 Jun;23(2):114-117. 10.3341/kjo.2009.23.2.114.

A Case of Radiation Retinopathy of Left Eye After Radiation Therapy of Right Brain Metastasis

• Hong KH
• Chang SD

• KMID: 754729
• DOI: http://doi.org/10.3341/kjo.2009.23.2.114

Abstract

A 37-year-old female, who had received modified radical mastectomy for cancer of her right breast, presented with decreased visual acuity in the left eye after radiation therapy for the management of the metastasis to her right brain 14 months ago. After ocular examination, we diagnosed her as radiation retinopathy. At the time of the first visit, the corrected best visual acuity was 0.4 in the left eye, and fundus examination revealed cotton wool spots and cystoid macular edema (CME). The findings in the right eye were normal except for cotton wool spots in the superior major arch. Fluorescein angiography (FA) showed marked telangiectasia and microaneurysms in her left eye but tiny microaneurysms in her right eye. Subsequent optical coherent tomography (OCT) showed CME. We injected intravitreal triamcinolone acetonide (TA). Two weeks after treatment, the visual acuity was improved to 0.6 and the retinal thickness was decreased. Three months later, the visual acuity in the left eye was dropped to 0.3 due to the recurrence of CME, so we injected intravitreal TA again. Five months later, visual acuity was improved to 0.5 and OCT revealed the improvement of CME. The incidence of radiation retinopathy is higher in the side nearer to radiation, but careful radiation blocking is also required on the opposite side of irradiation site considering the possibility of radiation retinopathy and careful observation is required on both sides of the eyes when performing fundus examination.

Keyword

Metastatic brain tumor; Radiation retinopathy; Radiation therapy

MeSH Terms

Adult
Brain Neoplasms/*radiotherapy/secondary
Breast Neoplasms/pathology/radiotherapy/surgery
Diagnosis, Differential
Female
Fluorescein Angiography
Follow-Up Studies
Fundus Oculi
Glucocorticoids/administration & dosage
Humans
Radiation Injuries/diagnosis/drug therapy/*etiology
Retina/pathology/*radiation effects
Retinal Diseases/diagnosis/drug therapy/*etiology
Tomography, Optical Coherence
Triamcinolone Acetonide/administration & dosage

Figure

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  Fig. 1 Axial section (A) coronal section (B) of T1 weighted MRI shows the brain metastasis at the right frontal lobe.

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  Fig. 2 Color fundus photograph and fluorescein angiography of both eyes. (A) Color fundus photograph of the left eye at initial examination shows diffuse macular edema, cotton wool spots and tortuous retinal vessel at the superotemporal arcade. (B) Fluorescein angiography of left eye at initial examination shows vascular telangiectasis, and aneurysmal dilation of retinal vessels with leakage of dye. (C) Color fundus photograph of the right eye at initial examination shows suspected cotton wool spot near superotemporal arcade and other findings are unremarkable. (D) Fluorescein angiography of right eye at initial examination shows minimal microaneurysms without macular edema.

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  Fig. 3 (A) Optical coherence tomogram shows marked cystoid macula edema. (B) Five months after intravitreal triamcinolone acetonide injection, optical coherence tomogram shows decreased macular thickness and marked improvement of cystoid macula edema.

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