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Treatment of radiation-induced maculopathy with fluocinolone acetonide

  • Oncology
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Abstract

Purpose

Chronic macular oedema is a well-known presentation of radiation-induced maculopathy (RM) following external beam photon therapy, plaque radiotherapy and proton beam radiotherapy for choroidal tumours. Current therapies vary in respect of efficacy and clinical benefit. The potential of fluocinolone acetonide (FAc) slow-release implants is unknown. We hypothesised that local continuous delivery of low-dose corticosteroids might improve symptoms of RM.

Methods

Five—two male and three female—patients from 37 to 68 years presented with RM following 106Ru-plaque brachytherapy or stereotactic radiation therapy (STx) with photons using a hypofractionated schedule of 5 × 10 Gy. All were treated with triamcinolone injections in first line and proofed to be refractory to steroids. In addition, two patients had received Ozurdex® implants as a second-line treatment, though without any clinical benefit. FAc slow-release implants were injected, and patients were followed up to monitor clinical improvement.

Results

All patients responded to therapy by means of a decrease in macular oedema. In four of five (80%) patients, visual acuity improved, and one patient showed stable visual acuity. No toxic effects or complications were observed.

Conclusion

Slow-release implants of FAc are a promising therapeutic potent steroid treatment option to benefit anatomical structures of the fovea and visual function. Slow-release implants with FAc reduce the frequency of intravitreal injections and the therapeutic burden.

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Authors and Affiliations

  1. Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Städtisches Klinikum Dessau, Klinik für Augenheilkunde, Auenweg 38, 06847, Dessau, Germany

    Lena Zimmermann, Christiane Kneifel, Luise Grajewski & Lothar Krause

  2. Akademisches Lehrkrankenhaus der Medizinischen Hochschule Brandenburg Theodor Fontane, Städtisches Klinikum Dessau, Klinik für Strahlentherapie und Radioonkologie, Dessau, Germany

    Ilja F. Ciernik

  3. University of Zürich, Zürich, Switzerland

    Ilja F. Ciernik

Authors
  1. Lena Zimmermann
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  2. Christiane Kneifel
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  3. Luise Grajewski
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  4. Ilja F. Ciernik
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  5. Lothar Krause
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Correspondence to Lena Zimmermann.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licencing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Zimmermann, L., Kneifel, C., Grajewski, L. et al. Treatment of radiation-induced maculopathy with fluocinolone acetonide. Graefes Arch Clin Exp Ophthalmol 258, 2535–2539 (2020). https://doi.org/10.1007/s00417-020-04804-7

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  • DOI: https://doi.org/10.1007/s00417-020-04804-7

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