Kogo Takahiro, Muraoka Yuki, Kubota Hirohito, Hata Masayuki, Tsujikawa Akitaka
Ophthalmology and Visual Sciences, Kyoto University, Kyoto, JPN.
Pediatrics, Kyoto University, Kyoto, JPN.
Cureus. 2025 Mar 6;17(3):e80178. doi: 10.7759/cureus.80178. eCollection 2025 Mar.
We report a case of transient peripheral retinal vessel whitening following whole-ventricle radiotherapy in a pediatric patient, which resolved spontaneously without signs of ischemia. An 11-year-old girl with a pituitary germinoma underwent chemotherapy and whole-ventricle radiotherapy (23.4 Gy in 13 fractions). At two months post-treatment, ultra-widefield scanning laser ophthalmoscopy revealed bilateral peripheral retinal vessel whitening, raising suspicion of nonperfusion areas. However, optical coherence tomography angiography (OCTA) confirmed preserved retinal blood flow without ischemia. Visual field testing did not reveal any abnormalities. No intervention was performed, and the whitening resolved spontaneously within two months. Unlike typical radiation retinopathy, this represents a reversible, non-ischemic process, which could be attributed to the limited radiation exposure received during whole-ventricle radiotherapy and vascular plasticity in young patients. Given that radiation retinopathy is generally considered uncommon below 45 Gy, this case presents a characteristic retinal vascular change occurring at lower radiation doses and underscores the importance of retinal evaluation even in low-dose irradiation settings. Non-invasive imaging techniques, such as OCTA and ultra-widefield scanning laser ophthalmoscopy, can be valuable for monitoring subtle radiation-induced retinal changes. Further research is needed to refine screening and management strategies for radiation-induced retinal effects.
我们报告了一例儿科患者在全脑室放疗后出现短暂性周边视网膜血管变白的病例，该症状自行消退，未出现缺血迹象。一名患有垂体生殖细胞瘤的11岁女孩接受了化疗和全脑室放疗（13次分割，共23.4 Gy）。治疗后两个月，超广角扫描激光检眼镜检查发现双侧周边视网膜血管变白，怀疑存在无灌注区。然而，光学相干断层扫描血管造影（OCTA）证实视网膜血流保留，无缺血表现。视野检查未发现任何异常。未进行干预，变白现象在两个月内自行消退。与典型的放射性视网膜病变不同，这是一个可逆的、非缺血性过程，可能归因于全脑室放疗期间接受的有限辐射暴露以及年轻患者的血管可塑性。鉴于一般认为低于45 Gy时放射性视网膜病变并不常见，该病例呈现出在较低辐射剂量下发生的特征性视网膜血管变化，并强调了即使在低剂量照射情况下进行视网膜评估的重要性。非侵入性成像技术，如OCTA和超广角扫描激光检眼镜检查，对于监测细微的辐射诱导视网膜变化可能很有价值。需要进一步研究以完善放射性视网膜效应的筛查和管理策略。
