Treatment of radiation maculopathy with intravitreal injection of bevacizumab (Avastin)

Purpose: To evaluate the safety and efficacy of intravitreal injection of bevacizumab as a treatment option for radiation maculopathy secondary to plaque radiotherapy. Methods: Interventional case series of five patients who developed radiation maculopathy complicating plaque radiotherapy with ruthenium 106 for choroidal melanoma. One to two intravitreal injections of bevacizumab (0.5 mL) were given, with an interval of 4 weeks between each injection. The main outcome measures were visual acuity and results of clinical ophthalmic examination and optical coherence tomography. Results: Preinjection visual acuity ranged from hand movements to 20/25. The average preinjection central macular thickness measured by optical coherence tomography was 351 mu m. Three of five patients had no improvement in macular edema after treatment with a single injection of bevacizumab at the 2-week follow-up (average postinjection central macular thickness, 287 mu m). Maculopathy in these three patients was long-standing (3-5 years). Improvement in visual acuity occurred in two patients (from 20/30 to 20/25 and from 20/25 to 20/20). Maculopathy in these two patients was diagnosed 1 week before treatment was offered. Resolution of macular edema occurred after a single injection in Patient 4 and after two injections in Patient 5. Patient 4 did not receive direct radiation to the fovea. All but one patient (Patient 5; dose, 8,000 cGy) received a radiation dose of 10,000 cGy to the tumor apex. Conclusions: In this series, treatment of radiation maculopathy with intravitreal injection of bevacizumab was useful in two patients as measured by improvement in visual acuity due to resolution of macular edema. These patients were younger and had macular edema for a shorter duration. One patient did not receive direct radiation to the fovea, and the other had a lower dose of radiation.