The New York Eye Cancer Center, New York, NY, USA.
Department of Ophthalmology, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
Eye (Lond). 2023 Apr;37(5):866-874. doi: 10.1038/s41433-022-02200-5. Epub 2022 Aug 16.
Radiation therapy has saved both sight and life for eye cancer patients. The most common methods include ophthalmic plaque brachytherapy and external beam techniques. However, subsequent dose-dependent radiation vasculopathy invariably occurs within and around the targeted zone. In 2006, Finger discovered that periodic intravitreal anti-vascular endothelial growth factor (anti-VEGF) bevacizumab could reverse and suppress intraocular radiation vasculopathy. At first, it was administered at the onset of radiation-related vision loss. Though bevacizumab induced regression of macular oedema, retinal haemorrhages and cotton-wool infarcts, most patients were left with residual retinal damage, manifest as metamorphopsia and loss of vision. These results led to earlier and earlier anti-VEGF interventions: first after signs of progressive radiation retinopathy, and then for signs of radiation maculopathy, and finally for high-risk eyes with no clinical signs of retinopathy. Earlier initiation of intravitreal anti-VEGF therapy typically resulted in greater restoration and preservation of macular anatomy, reductions of retinal haemorrhages, resolution of cotton-wool spots and vision preservation. Recent research on optical coherence tomography angiography (OCT-A) has revealed that radiation vasculopathy occurs prior to clinical ophthalmic signs or symptoms. Therefore, it seemed reasonable to consider treating high-risk patients (considered certain to eventually develop radiation maculopathy) to prevent or delay vision loss. Herein, we describe the evolution of treatment for radiation maculopathy as well as recent research supporting anti-VEGF treatment of high-risk patients immediately following radiation to maximize vision outcomes.
放射治疗为眼癌患者挽救了视力和生命。最常见的方法包括眼贴敷近距离放疗和外部束放射治疗。然而，随后不可避免地会在靶区及其周围发生剂量依赖性的放射性血管病变。2006 年，Finger 发现周期性玻璃体内抗血管内皮生长因子（anti-VEGF）贝伐单抗可以逆转和抑制眼内放射性血管病变。起初，它是在与辐射相关的视力丧失时开始使用的。尽管贝伐单抗可使黄斑水肿、视网膜出血和棉絮状梗塞消退，但大多数患者仍残留视网膜损伤，表现为视物变形和视力丧失。这些结果导致更早、更频繁地使用抗 VEGF 干预治疗：首先是在进行性放射性视网膜病变的迹象出现后，然后是在放射性黄斑病变的迹象出现后，最后是在有高危但没有临床视网膜病变迹象的眼睛中使用。更早开始玻璃体内抗 VEGF 治疗通常会导致黄斑解剖结构更好地恢复和保留、视网膜出血减少、棉絮状斑点消退以及视力保存。最近对光相干断层扫描血管造影术（OCT-A）的研究表明，放射性血管病变先于临床眼科迹象或症状出现。因此，考虑对高危患者（被认为肯定会最终发展为放射性黄斑病变）进行治疗以预防或延迟视力丧失似乎是合理的。在此，我们描述了放射性黄斑病变治疗的演变，以及支持在放射治疗后立即对高危患者进行抗 VEGF 治疗以最大限度地提高视力结果的最新研究。
