Severe radiation retinopathy and optic neuropathy after brachytherapy for choroidal melanoma, treated by hyperbaric oxygen

Purpose: To report a case of retinal detachment with unique optical coherence tomography (OCT) findings after Gamma Knife® (GK; Elekta Instrument AB, Stockholm, Sweden) treatment for choroidal melanoma (CM). Case Report: A 48-year-old woman underwent GK therapy for CM in her right eye from the macula to the temporal side. While the tumor subsequently shrank, the patient developed radiation retinopathy, which was treated with laser photocoagulation. The tumor lesions later subsided; however, her visual acuity (VA) decreased 8 years after the initial treatment. Although the tumor lesions in the right eye had become scarred, a bullous retinal detachment with fixed folds occurred in the superior-nasal quadrants. OCT examination revealed a preretinal membrane, vitreoretinal traction, and an inner retinal break; however, no outer retinal break was clearly detectable. MRI scans showed no increase in tumorous lesions, and 123I-IMP SPECT imaging showed no photon accumulation. Thus, it was determined that there was no tumor activity. The corrected VA in her right eye was light perception, and it was determined that there was no indication for vitreous surgery. Conclusion: In this case, an inner retinal break was formed by the vitreoretinal traction around the scarred tumor and radiation retinopathy, thus suggesting the possibility of the development of a rhegmatogenous retinal detachment presumably complicated with an outer retinal break.

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Radiation Retinopathy and Neuropathy following Plaque Therapy of Small Choroidal Melanoma

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2010.07.1422 ◽

2010 ◽

Vol 78 (3) ◽

pp. S611

Author(s):

D. Wilkinson ◽

V. Torres ◽

M. Kolar ◽

P. Fleming ◽

A. Singh

Keyword(s):

Choroidal Melanoma ◽

Radiation Retinopathy

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Hyperbaric Oxygen in the Treatment of Radiation-induced Optic Neuropathy

Ophthalmology ◽

10.1016/s0161-6420(86)33617-0 ◽

1986 ◽

Vol 93 (8) ◽

pp. 1083-1088 ◽

Cited By ~ 70

Author(s):

John Guy ◽

Norman J. Schatz

Keyword(s):

Hyperbaric Oxygen ◽

Optic Neuropathy ◽

Radiation Induced

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The Role of Combined Therapy in the Treatment of Retinopathy and Optic Neuropathy Due to Radiotherapy in the Uveal Melanoma

Asian Journal of Oncology ◽

10.1055/s-0040-1701391 ◽

2020 ◽

Vol 6 (01) ◽

pp. 01-02

Author(s):

Yasemin Benderli Cihan

Keyword(s):

Uveal Melanoma ◽

Optic Neuropathy ◽

Combined Therapy ◽

Tumor Resection ◽

Transpupillary Thermotherapy ◽

Particle Radiation ◽

Radiation Retinopathy ◽

Low Incidence ◽

Plaque Brachytherapy

Abstract Introduction Uveal melanoma has a relatively low incidence. Transpupillary thermotherapy (TTT), hypofractioned stereotactic radiotherapy (RT), stereotactic radiosurgery, plaque brachytherapy, charged particle radiation therapy, local tumor resection, enucleation, and exantation are applied in the treatment. Methods The importance given to radiotherapy has increased to get more satisfactory results while treating the patient. However, it is the treatment of radiation retinopathy and optic neuropathy from complications. Results Radiation retinopathy and optic neuropathy are the most important complications related to radiotherapy in the treatment of uveal melanoma. In recent years, many studies have been performed on the treatment of radiation retinopathy and optic neuropathy. Conclusion The consecutive use of triamcinolone in combination with anti-VEGF supports that it may be a future therapeutic agent in the treatment of complications.

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Late-stage sequela of an isolated optic neuropathy after acute magnesium valproate overdose: A case report

European Journal of Ophthalmology ◽

10.1177/1120672120974943 ◽

2020 ◽

pp. 112067212097494

Author(s):

Xuhao Chen ◽

Haohao Di ◽

Ying Hong ◽

Chun Zhang

Keyword(s):

Visual Acuity ◽

Optic Nerve ◽

Hyperbaric Oxygen ◽

Optic Neuropathy ◽

Visual Function ◽

Hyperbaric Oxygen Therapy ◽

Oxygen Therapy ◽

Early Stage ◽

Systemic Treatments ◽

The Right

Background: Magnesium valproate is a valproic acid (VPA) derivative that is widely used for the treatment of epilepsy and bipolar disorders. Acute overdose of VPA may cause complicated systemic syndromes; however, the reports of ocular sequelae caused by toxic optic neuropathy (TON) are rare. Case presentation: We present a case of a 19-year-old female with bilateral damage to visual function after acute VPA overdose. She was comatose and received systemic treatments for 1 month, during which she suffered a substantial loss of visual function without any evident neurological sequelae. The first recorded visual acuity was no light perception in the right eye (OD) and hand motion in the left eye (OS). Her best-corrected visual acuity improved to 20/100 OS after 4 months of hyperbaric oxygen therapy and neurotrophic treatments. Her visual field was limited to an inferior nasal area OS. Therefore, a diagnosis of TON was made. Her visual function remained stable in the left eye, but did not recover in the right eye during the 5-month follow-up. We found damage to the optic nerve pathway during ophthalmic examinations. Conclusion: We report a rare case of TON caused by acute VPA overdose. Hyperbaric oxygen therapy, and neuroprotective and neurotrophic treatments might be effective at the early stage but cannot fully reverse the damage to the optic nerve. The present case indicates the potential neurotoxicity of VPA. It is crucial to determine the severity of an isolated optic nerve sequela caused by VPA overdose, though it might be rare as observed in previous reports. Further confirmation of the likelihood of its causation and its pathophysiology is needed in the future.

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