Side effects after radiotherapy of age-related macular degeneration with the Nijmegen technique

Abstract.

Background: In a randomized trial concerning radiotherapy for age-related macular degeneration, fluorescein angiograms were taken of controls and patients. In this study the frequency of side effects in eyes receiving radiotherapy with the Nijmegen technique is compared with the findings in the eyes of controls. Methods: Patients receiving treatment were irradiated by two isocentric photon beams in four fractions of 6 Gy that were directed to the macular area at 30° and –30° with regard to the optical axis. The most recent fluorescein angiograms of the randomized eyes (32 treated and 31 control eyes) were scored by two independent researchers, using a scoring form with nine features of radiation retinopathy: nonperfusion, macular edema, microaneurysms, retinal hemorrhages, cotton-wool spots, perifoveal telangiectasis, vascular sheathing, retinal neovascularization, and radiation-associated choroidal neovasculopathy. The results were graded as: no retinopathy (grade 0), mild retinopathy (grade 1), moderate retinopathy (grade 2), and severe retinopathy (grade 3). Results: In the treated group 6 patients (18.8%) were grade 1, 10 patients (31.2%) were grade 2 and 7 patients (21.9%) were grade 3. In the control group 9 patients (29.0%) were grade 1, 11 patients (35.5%)were grade 2 and 2 patients (6.5%) were grade 3. There were no patients with retinal neovascularization. Conclusion: With the Nijmegen technique a relatively high dose of radiation can be applied to a small retinal area. In only a minority of cases does some evidence of radiation retinopathy occur.