Eye disorder therapies/ruthenium-106

Abstract

Radiation-induced maculopathy and lack of efficacy: 4 case reports In a case report of 5 patients, presented from September 2018 to July 2019, 4 patients including 2 men and 2 women aged 55 years–70s [not all ages stated] were described, who developed radiation-induced maculopathy (RM) during treatment with ruthenium-106 for malignant choroidal melanoma. Additionally, the patients exhibited lack of efficacy with dexamethasone, bevacizumab or triamcinolone for the RM [dosages not stated; not all routes stated]. Case 1: An approximately 67-year-old man developed RM during treatment with ruthenium-106. Additionally, he exhibited lack of efficacy with dexamethasone for RM. The man, who had malignant choroidal melanoma, received treatment with ruthenium-106 [106-ruthenium-plaque brachytherapy] in August 2015 (at the age of 66 years). He additionally received radiation therapy. Prior to the ruthenium-106 therapy, the visual acuity was noted as 0.2. Nine months after the ruthenium-106 therapy, an uneventful cataract surgery was performed due to cataracta complicata. However, 16 months after the ruthenium-106 therapy, he developed RM in January 2017 (approximately at the age of 67 years). At the time, visual acuity was found to be 0.32. Therefore, he received four intravitreal dexamethasone [Ozurdex] implants within 12 months. During follow-up 38 months after the ruthenium-106 therapy (October 2018), the visual acuity was found to be 0.4. The optical coherence tomography (OCT) revealed a recalcitrant macular oedema. Thus, lack of efficacy with dexamethasone was considered. Therefore, he received treatment with fluocinolone acetonide [Iluvien] in November 2018. After 7 months, visual acuity increased to 0.9. Repeat OCT revealed resolution of macular oedema with decreased macular thickness. Additionally, the intraocular pressure was found to be 16–18mm Hg, and he was found to have stable radiation scar and a regressing tumour. Case 3: An approximately 55-year-old woman exhibited lack of efficacy with bevacizumab and triamcinolone for RM. The woman with malignant choroidal melanoma, underwent fractionated radiosurgery in January 2016 (at the age of 54 years). She was then treated with a pars plana vitrectomy and endoresection in February 2016. She received three intravitreal bevacizumab [Avastin] injections until February 2017 and one intravitreal triamcinolone injection in June 2017 (approximately at the age of 55 years) for RM. She was pseudophakic and reported a subjective progressive visual loss. Additionally, she had persistent macular oedema. Thus, lack of efficacy with bevacizumab and triamcinolone was considered. Due to persistent macular oedema, she received treatment with fluocinolone acetonide [Iluvien] in September 2018. As a result, a slight subjective improvement in visual acuity was observed. Intraocular pressure was found to be normal without medication. After 8 months and on optical coherence tomography, the macular oedema resolved, and the macular thickness decreased in the parafoveal retina. Additionally, visual acuity was found to be stable at hand motion, and she was found to have stable radiation scar and endo-resection site. Case 4: A man in his 70s exhibited lack of efficacy with triamcinolone for RM. The man presented with choroidal melanoma of the right eye in April 2010 (at the age of 68 years). He was treated with proton beam therapy (PBT). After PBT, a stable radiation scar and a visual acuity of 0.8 was observed. During follow-up in March 2017, visual acuity dropped to 0.5 and RM was evoked. He received four intravitreal triamcinolone injections until October 2017 followed by cataract surgery with triamcinolone injection in March 2018. Post-surgery, a chronic macular oedema was observed. Thus, lack of efficacy with triamcinolone was considered. In January 2019, the visual acuity was found to be 0.4 and fluocinolone acetonide [Iluvien] was implanted. After 4 months, macular oedema regressed and the visual acuity improved to 0.5. The macular thickness decreased and intraocular pressure level after implantation was found to be 16mm Hg. Additionally, stable radiation scar was noted. Case 5: A woman in her 60s exhibited lack of efficacy with bevacizumab and triamcinolone for RM. The woman, who had central choroidal haemangioma, was treated with proton beam therapy (PBT) in August 2009 (at the age of 60 years). After PBT, the radiation scar was found to be stable. The baseline visual acuity varied between 0.3 and 0.9 due to serous exudates affecting the macular. She received two intravitreal bevacizumab injections until September 2015 and three intravitreal triamcinolone injections from October 2015 to June 2017 for RM. Despite treatment, she had chronic macular oedema without measurable improvements and also complained of progressive vision loss. Thus, lack of efficacy with bevacizumab and triamcinolone was considered. In July 2019, fluocinolone acetonide [Iluvien] was implanted. At the time of fluocinolone acetonide therapy, she was phakic. After 2 months, a macular oedema resolved and the visual acuity increased. Additionally, the macular thickness decreased and the maximum post-operative intraocular pressure was found to be 17mm Hg. She was also found to have stable radiation scar.