Original ArticlesRadiation-induced optic neuropathy – observation versus intravitreal treatment
Review articleOpen access

PurposeTo compare intravitreal therapy with the natural course of radiation optic neuropathy after primary proton beam therapy for choroidal melanoma with respect to long-term visual acuity and development of optic atrophyDesignRetrospective comparative case seriesMethodsInclusion criteria: Patients treated with primary proton beam therapy for choroidal melanoma with a minimum follow-up of 24 months after the occurrence of radiation optic neuropathy and optic disc imaging during follow-up.Exclusion criteriaPathologic condition of the optic disc before irradiation, intravitreal therapy to treat cystoid macular edema not originating from the optic disc.ResultsOf 93 patients, 48 were observed only after radiation optic neuropathy and 45 were treated with intravitreal therapy (triamcinolone, bevacizumab, and/or dexamethasone). Median follow-up was 55 months (29-187 months), median interval between onset of radiation optic neuropathy and the last patient visit was 34 months (24-125 months). Of 48 observed patients, 41 (85.4%) developed an optic atrophy after a median of 14 months (3-86 months) after radiation optic neuropathy, and of 45 intravitreally treated patients, 34 (75.5%) presented with an optic atrophy after a median of 12.5 months (1-55 months) following optic neuropathy, indicating no statistical significant difference between both groups. Comparing the change in visual acuity from occurence of optic neuropathy to final visual acuity, no statistical significant difference was found between both groups (p = 0.579).ConclusionPatients treated with intravitreal therapy for radiation optic neuropathy showed no statistically significant differences compared with patients only observed, related to visual acuity or optic atrophy development.

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