Skip to main content

Ocular Complications of Radiotherapy

  • Chapter
  • First Online:
Clinical Ophthalmic Oncology

Abstract

Although radiotherapy is the standard treatment for most intraocular malignancies, various ocular complications may occur, including radiation-induced dry eye, cataract, secondary glaucoma from neovascularization of the iris, scleral necrosis, retinopathy, and optic neuropathy. In this chapter we review the ocular side effects of radiation administered from brachytherapy, proton beam radiotherapy, and external beam radiotherapy and their potential treatments. Particular emphasis will be placed on radiation retinopathy and optic neuropathy, the two most visually significant complications of radiotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Earle J, Kline RW, Robertson DM. Selection of iodine 125 for the Collaborative Ocular Melanoma Study. Arch Ophthalmol. 1987;105(6):763–4.

    Article  PubMed  CAS  Google Scholar 

  2. Finger PT, Lu D, Buffa A, DeBlasio DS, Bosworth JL. Palladium-103 versus iodine-125 for ophthalmic plaque radiotherapy. Int J Radiat Oncol Biol Phys. 1993;27(4):849–54.

    Article  PubMed  CAS  Google Scholar 

  3. Thomson RM, Taylor RE, Rogers DW. Monte Carlo dosimetry for 125I and 103Pd eye plaque brachytherapy. Med Phys. 2008;35(12):5530–43.

    Article  PubMed  CAS  Google Scholar 

  4. Nag S, Quivey JM, Earle JD, Followill D, Fontanesi J, Finger PT, American Brachytherapy Society. The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas. Int J Radiat Oncol Biol Phys. 2003;56(2):544–55.

    Article  PubMed  Google Scholar 

  5. Damato B, Patel I, Campbell IR, Mayles HM, Errington RD. Local tumor control after 106Ru brachytherapy of choroidal melanoma. Int J Radiat Oncol Biol Phys. 2005;63(2):385–91.

    Article  PubMed  Google Scholar 

  6. Wilkinson DA, Kolar M, Fleming PA, Singh AD. Dosimetric comparison of 106Ru and 125I plaques for treatment of shallow (<or= 5 mm) choroidal melanoma lesions. Br J Radiol. 2008;81(970):784–9. doi:10.1259/bjr/76813976x. Epub 2008 Jul 15.

    Article  PubMed  CAS  Google Scholar 

  7. Finger PT, Ho TK, Fastenberg DM, Hyman RA, Stroh EM, Packer S, Perry HD. Intraocular radiation blocking. Invest Ophthalmol Vis Sci. 1990;31(9):1724–30.

    PubMed  CAS  Google Scholar 

  8. Oliver SC, Leu MY, DeMarco JJ, Chow PE, Lee SP, McCannel TA. Attenuation of iodine 125 radiation with vitreous substitutes in the treatment of uveal melanoma. Arch Ophthalmol. 2010;128(7):888–93.

    Article  PubMed  Google Scholar 

  9. Kiratli H, Yilmaz PT, Sargon M. Ultrastructural alterations in extraocular muscles following iodine-125 brachytherapy for uveal melanoma. Strabismus. 2007;15(2):103–9.

    Article  PubMed  Google Scholar 

  10. Sener EC, Kiratli H, Gedik S, Sanac AS. Ocular motility disturbances after episcleral plaque brachytherapy for uveal melanoma. J AAPOS. 2004;8(1):38–45.

    Article  PubMed  Google Scholar 

  11. Archer DB, Amoaku WM, Gardiner TA. Radiation retinopathy – clinical, histopathological, ultrastructural and experimental correlations. Eye. 1991;5:239–51.

    Article  PubMed  Google Scholar 

  12. Irvine AR, Wood IS. Radiation retinopathy as an experimental model for ischemic proliferative retinopathy and rubeosis iridis. Am J Ophthalmol. 1987;103:790–7.

    PubMed  CAS  Google Scholar 

  13. Midena E, Segato T, Valenti M, et al. The effect of external eye irradiation on choroidal circulation. Ophthalmology. 1996;103:1651–60.

    Article  PubMed  CAS  Google Scholar 

  14. Heimann H, Coupland SE, Gochman R, Hellmich M, Foerster MH. Alterations in expression of mucin, tenascin-c and syndecan-1 in the conjunctiva following retinal surgery and plaque radiotherapy. Graefes Arch Clin Exp Ophthalmol. 2001;239(7):488–95.

    Article  PubMed  CAS  Google Scholar 

  15. Durkin SR, Roos D, Higgs B, Casson RJ, Selva D. Ophthalmic and adnexal complications of radiotherapy. Acta Ophthalmol Scand. 2007;85(3):240–50.

    Article  PubMed  Google Scholar 

  16. Quivey JM, Char DH, Phillips TL, Weaver KA, Castro JR, Kroll SM. High intensity 125-iodine (125I) plaque treatment of uveal melanoma. Int J Radiat Oncol Biol Phys. 1993;26(4):613–8.

    Article  PubMed  CAS  Google Scholar 

  17. Lumbroso-Le Rouic L, Charif Chefchaouni M, Levy C, Plancher C, Dendale R, Asselain B, et al. 125I plaque brachytherapy for anterior uveal melanomas. Eye. 2004;18(9):911–6.

    Article  PubMed  CAS  Google Scholar 

  18. Finger PT. Radiation therapy for choroidal melanoma. Surv Ophthalmol. 1997;42(3):215–32.

    Article  PubMed  CAS  Google Scholar 

  19. Parsons JT, Bova FJ, Firzgerald CR, et al. Severe dry eye syndrome following external beam irradiation. Int J Radiat Oncol Biol Phys. 1994;30:775–80.

    Article  PubMed  CAS  Google Scholar 

  20. Muller K, Nowak PJ, Naus N, et al. Lacrimal gland radiosensitivity in uveal melanoma patients. Int J Radiat Oncol Biol Phys. 2009;74(2):497–502.

    Article  PubMed  Google Scholar 

  21. Petrovich Z, McDonnell JM, Palmer D, Langholz BM, Liggett PE. Histopathologic changes following irradiation for uveal tract melanoma. Am J Clin Oncol. 1994;17(4):298–306.

    Article  PubMed  CAS  Google Scholar 

  22. Stack R, Elder M, Abdelaal A, Hidajat R, Clemett R, et al. New Zealand experience of I125 brachytherapy for choroidal melanoma. Clin Exp Ophthalmol. 2005;33(5):490–4.

    Article  Google Scholar 

  23. Kaliki S, Shields CL, Rojanaporn D, Badal J, Devisetty L, Emrich J, Komarnicky L, Shields JA. Scleral necrosis after plaque radiotherapy of uveal melanoma: a case–control study. Ophthalmology. 2013;120(5):1004–11. pii: S0161-6420(12)01008-1. 10.1016.

    Article  PubMed  Google Scholar 

  24. Horwath-Winter J, Schneider M, Wackernagel W, et al. Influence of single-fraction Gamma-Knife radiosurgery on ocular surface and tear function in choroidal melanoma patients. Br J Ophthalmol. 2013;97(4):466–70.

    Article  PubMed  Google Scholar 

  25. Finger PT. Tumour location affects the incidence of cataract and retinopathy after ophthalmic plaque radiation therapy. Br J Ophthalmol. 2000;84(9):1068–70.

    Article  PubMed  CAS  Google Scholar 

  26. Char DH, Lonn LI, Margolis LW. Complications of cobalt plaque therapy of choroidal malanomas. Am J Ophthalmol. 1977;84(4):536–41.

    PubMed  CAS  Google Scholar 

  27. Detorakis ET, Engstrom Jr RE, Wallace R, Straatsma BR. Iris and anterior chamber angle neovascularization after iodine 125 brachytherapy for uveal melanoma. Ophthalmology. 2005;112(3):505–10.

    Article  PubMed  Google Scholar 

  28. Fernandes BF, Weisbrod D, Yucel YH, et al. Neovascular glaucoma after stereotactic radiotherapy for juxtapapillary choroidal melanoma: histopathologic and dosimetric findings. Int J Radiat Oncol Biol Phys. 2011;80(2):377–84.

    Article  PubMed  Google Scholar 

  29. Aiello LP, Avery RL, Arrigg PG, et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med. 1994;331:1480–7.

    Article  PubMed  CAS  Google Scholar 

  30. Yeung SN, Paton KE, Waite C, Maberley DA. Intravitreal bevacizumab for iris neovascularization following proton beam irradiation for choroidal melanoma. Can J Ophthalmol. 2010;45(3):269–73.

    Article  PubMed  Google Scholar 

  31. Yanoff M, Duker JS, Augsburger JJ. Ophthalmology. 2nd ed. St Louis: Mosby; 2004.

    Google Scholar 

  32. Cogan DG, Donaldson DD, Reese AB. Clinical and pathological characteristics of radiation cataract. AMA Arch Ophthalmol. 1952;47(1):55–70.

    Article  PubMed  CAS  Google Scholar 

  33. Ferrufino-Ponce ZK, Henderson BA. Radiotherapy and cataract formation. Semin Ophthalmol. 2006; 21(3):171–80.

    Article  PubMed  Google Scholar 

  34. Collaborative Ocular Melanoma Study Group. Incidence of cataract and outcomes after cataract surgery in the first 5 years after iodine 125 brachytherapy in the Collaborative Ocular Melanoma Study COMS Report No. 27. Ophthalmology. 2007;114(7):1363–71.

    Article  Google Scholar 

  35. Fontanesi J, Meyer D, Xu S, Tai D. Treatment of choroidal melanoma with I-125 plaque. Int J Radiat Oncol Biol Phys. 1993;26(4):619–23.

    Article  PubMed  CAS  Google Scholar 

  36. Muller K, Naus N, Nowak P, et al. Fractionated stereotactic radiotherapy for uveal melanoma, late clinical results. Radiother Oncol. 2012;102(2):219–24.

    Article  PubMed  Google Scholar 

  37. Archer DB, Gardiner TA. Ionizing radiation and the retina. Curr Opin Ophthalmol. 1994;5(3):59–65.

    Article  PubMed  CAS  Google Scholar 

  38. Gillies MC. Regulators of vascular permeability: potential sites for intervention in the treatment of macular edema. Doc Ophthalmol. 1999;97(3–4):251–60.

    Article  PubMed  CAS  Google Scholar 

  39. Jermak CM, Dellacroce JT, Heffez J, Peyman GA. Triamcinolone acetonide in ocular therapeutics. Surv Ophthalmol. 2007;52(5):503–22.

    Article  PubMed  CAS  Google Scholar 

  40. Rosenfeld PJ, Schwartz SD, Blumenkranz MS, Miller JW, Haller JA, Reimann JD, et al. Maximum tolerated dose of a humanized anti-vascular endothelial growth factor antibody fragment for treating neovascular age-related macular degeneration. Ophthalmology. 2005;112(6):1048–53.

    Article  PubMed  Google Scholar 

  41. Finger PT. Radiation retinopathy is treatable with anti- vascular endothelial growth factor bevacizumab (Avastin). Int J Radiat Oncol Biol Phys. 2008;70(4): 974–7.

    Article  PubMed  CAS  Google Scholar 

  42. Hykin PG, Shields CL, Shields JA, Arevalo JF. The efficacy of focal laser therapy in radiation-induced macular edema. Ophthalmology. 1998;105(8):1425–9.

    Article  PubMed  CAS  Google Scholar 

  43. Kinyoun JL, Zamber RW, Lawrence BS, Barlow WE, Arnold AM. Photocoagulation treatment for clinically significant radiation macular oedema. Br J Ophthalmol. 1995;79(2):144–9.

    Article  PubMed  CAS  Google Scholar 

  44. Kinyoun JL, Chittum ME, Wells CG. Photocoagulation treatment of radiation retinopathy. Am J Ophthalmol. 1988;105(5):470–8.

    PubMed  CAS  Google Scholar 

  45. Levin LA, Gragoudas ES, Lessell S. Endothelial cell loss in irradiated optic nerves. Ophthalmology. 2000;107(2):370–4.

    Article  PubMed  CAS  Google Scholar 

  46. Kline LB, Kim JY, Ceballos R. Radiation optic neuropathy. Ophthalmology. 1985;92(8):1118–26.

    Article  PubMed  CAS  Google Scholar 

  47. Miller NR. Radiation-induced optic neuropathy: still no treatment. Clin Exp Ophthalmol. 2004;32(3): 233–5.

    Article  Google Scholar 

  48. Danesh-Meyer HV. Radiation-induced optic neuropathy. J Clin Neurosci. 2008;15(2):95–100.

    Article  PubMed  Google Scholar 

  49. Brown GC, Shields JA, Sanborn G, Augsburger JJ, Savino PJ, Schatz NJ. Radiation optic neuropathy. Ophthalmology. 1982;89(12):1489–93.

    Article  PubMed  CAS  Google Scholar 

  50. Marwaha G, Wilkinson A, Bena J, Macklis R, Singh AD. Dosimetric benefit of a new ophthalmic radiation plaque. Int J Radiat Oncol Biol Phys. 2012;84(5): 1226–30.

    Article  PubMed  Google Scholar 

  51. Monroe AT, Bhandare N, Morris CG, Mendenhall WM. Preventing radiation retinopathy with hyperfractionation. Int J Radiat Oncol Biol Phys. 2005;61: 856–64.

    Article  PubMed  Google Scholar 

  52. Bhandare N, Monroe AT, Morris CG, et al. Does altered fractionation influence the risk of radiation-induced optic neuropathy? Int J Radiat Oncol Biol Phys. 2005;62:1070–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Tara A. McCannel MD, PhD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Kamrava, M., Lamb, J., McCannel, T.A. (2014). Ocular Complications of Radiotherapy. In: Singh, A., Damato, B. (eds) Clinical Ophthalmic Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40489-4_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-40489-4_11

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-40488-7

  • Online ISBN: 978-3-642-40489-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics