Purpose : To evaluate the efficacy of intravitreal dexamethasone implant 0.7 mg compared to intravitreal ranibizumab in radiation maculopathy with macular edema secondary to plaque brachytherapy in choroidal melanoma. Methods : Sixteen eyes diagnosed of radiation maculopathy with macular edema (grade 3-5 according to Horgan classification) secondary to plaque brachytherapy were included in a retrospective study. Eight patients (3 m, 5 f, age range 54-76) were treated with intravitreal ranibizumab and 7 patients (4 m, 4 f, age range 33-78) received dexamethasone intravitreal implant. Visual acuity and foveal thickness using spectral domain optical coherence tomography were evaluated. Results : In ranibizumab (Ra) and in dexamethasone (Dex) groups, respectively, mean calculated irradiation to the fovea was 5.02±5.44 Gy (range 0-12.4) and 4.78±3.34 Gy (range 0.27-10.27 Gy) (ns), and mean time from brachytherapy to maculopathy development was 21±8 months (range 13-34 months) and 20±5 months (range 14-29 months)(ns) . In the ranibizumab group (3 eyes with macular edema grade 3, 1 eye with grade 4, and 4 grade 5), mean follow up was 33±15 months (range 7-52 months); patients received a mean number of 7.8±3.9 injections (range 3-13). In the dexamethasone group (3 eyes with macular edema grade 3, 2 eye with grade 4, and 3 eyes with grade 5), mean follow up was 22±7 months (range 11-31 months) (vs RA p=0.090, Wilcoxon's test), and patients received a mean number of 2.1±0.8 injections (range 1-3) (vs RA p<0.001, Wilcoxon's test). Mean visual acuity (at baseline: Ra: 0.49±0.14 logMAR; Dex: 0.45±0.18 logMAR) improved significantly in both groups (at last follow-up visit : Ra: 0.34±0.13 logMAR; Dex: 0.27±0.15 logMAR, respectively P=0.012 and P=0.011, Wilcoxon signed rank test). Foveal thickness (at baseline: Ra: 459±74 microns; Dex: 435±72 microns) reduced significantly in both groups (at last follow-up visit: RA: 241±58 microns; Dex: 254±44 microns, both P=0.012, Wilcoxon signed rank test). Conclusions : Both ranibizumab and dexamethasone are effective treatments for macular edema secondary to plaque brachytherapy for uveal melanoma. Dexamethasone treated patients required less injections to achieve anatomical and functional improvement.
DEXAMETHASONE INTRAVITREAL IMPLANT VS INTRAVITREAL RANIBIZUMAB FOR THE TREATMENT OF MACULAR EDEMA SECONDARY TO BRACHYTHERAPY FOR CHOROIDAL MELANOMA
Gagliano C;
2016-01-01
Abstract
Purpose : To evaluate the efficacy of intravitreal dexamethasone implant 0.7 mg compared to intravitreal ranibizumab in radiation maculopathy with macular edema secondary to plaque brachytherapy in choroidal melanoma. Methods : Sixteen eyes diagnosed of radiation maculopathy with macular edema (grade 3-5 according to Horgan classification) secondary to plaque brachytherapy were included in a retrospective study. Eight patients (3 m, 5 f, age range 54-76) were treated with intravitreal ranibizumab and 7 patients (4 m, 4 f, age range 33-78) received dexamethasone intravitreal implant. Visual acuity and foveal thickness using spectral domain optical coherence tomography were evaluated. Results : In ranibizumab (Ra) and in dexamethasone (Dex) groups, respectively, mean calculated irradiation to the fovea was 5.02±5.44 Gy (range 0-12.4) and 4.78±3.34 Gy (range 0.27-10.27 Gy) (ns), and mean time from brachytherapy to maculopathy development was 21±8 months (range 13-34 months) and 20±5 months (range 14-29 months)(ns) . In the ranibizumab group (3 eyes with macular edema grade 3, 1 eye with grade 4, and 4 grade 5), mean follow up was 33±15 months (range 7-52 months); patients received a mean number of 7.8±3.9 injections (range 3-13). In the dexamethasone group (3 eyes with macular edema grade 3, 2 eye with grade 4, and 3 eyes with grade 5), mean follow up was 22±7 months (range 11-31 months) (vs RA p=0.090, Wilcoxon's test), and patients received a mean number of 2.1±0.8 injections (range 1-3) (vs RA p<0.001, Wilcoxon's test). Mean visual acuity (at baseline: Ra: 0.49±0.14 logMAR; Dex: 0.45±0.18 logMAR) improved significantly in both groups (at last follow-up visit : Ra: 0.34±0.13 logMAR; Dex: 0.27±0.15 logMAR, respectively P=0.012 and P=0.011, Wilcoxon signed rank test). Foveal thickness (at baseline: Ra: 459±74 microns; Dex: 435±72 microns) reduced significantly in both groups (at last follow-up visit: RA: 241±58 microns; Dex: 254±44 microns, both P=0.012, Wilcoxon signed rank test). Conclusions : Both ranibizumab and dexamethasone are effective treatments for macular edema secondary to plaque brachytherapy for uveal melanoma. Dexamethasone treated patients required less injections to achieve anatomical and functional improvement.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
