Radiotherapy for age-related macular degeneration: risk factors of complications, prevention and treatment of side-effects

Purpose: To analyze the retinal and choroidal side-effects of radiotherapy given for age-related macular degeneration (ARMD) and to describe the risk factors of these complications and their treatment. Material and methods: Two hundred and ninety five eyes in 270 patients with ARMD were treated using radiotherapy. Nineteen patients had diabetes. The doses were as follows: 15 Gy or less (4 eyes); 16 Gy/4 fractions (113 eyes) ; 18 Gy/5 fractions (35 eyes); 20 Gy/5 fractions (123 eyes); 24 Gy/6 fracti ons (2 eyes); 28.8 Gy/8 fractions (17 eyes); more than 28.8 Gy (1 eye). Pat ients had a regular follow-up visit with visual acuity, contrast sensitivit y evaluation, biomicroscopic fundus examination, fluorescein and ICG angiog raphies every six months over a mean period of 15 months. Results: Radiation retinopathy was noted in 15 eyes, a bilateral neovascula r glaucoma in one patient, ischemic optic neuropathy in 5 eyes, choroidal t elangiectasiae in 19 eyes, venous occlusion in 2 eyes, oedematous retinopat hy with major exsudation (ORME) in 31 eyes, and choroidal hematoma in 8 eye s. Radiation retinopathy, choroidal telangiectasiae and ORME were related t o radiation dose. Radiation retinopathy was more severe and more frequent i n patients with diabetes. Choroidal telangiectasiae were diagnosed with ICG angiography and were treated early with laser. Conclusion: Radiotherapy for ARMD should not be done in patients with diabe tes. Hypofractionation is not recommended. ICG angiography should be consid ered essential in the followup of patients treated with radiotherapy.