Na podstawie dotychczasowych badań można przyjąć następujący schemat postępowania w retinopatii popromiennej:

  • ocena retinopatii: badanie dna oka/angiografia fluoresceinowa/OCT
  • obrzęk plamki: fotokoagulacja laserowa/triamcynolon/swoista terapia anty-VEGF
  • mikroaneuryzmaty: fotokoagulacja punktowa
  • strefy bezprzepływowe: fotokoagulacja laserowa/ewentualnie panfotokoagulacja
  • neowaskularyzacja: panfotokoagulacja/swoista terapia anty-VEGF.

Prawidłowe odpowiedzi: 1. d, 2. b, 3. d

Piśmiennictwo

1. American Academy of Ophthalmology. Basic and Clinical Science Course 2011-2012, Section 12: Retina and Vitreous. Singapur: LEO, 2011.

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

3. Kinyoun JL, Zamber RW, Lawrence BS, et al. Photocoagulation treatment for clinically significant radiation macular oedema. Br J Ophthalmol 1995;79:144-9.

4. Archer DB. Doyne Lecture. Responses of retinal and choroidal vessels to ionising radiation. Eye (Lond) 1993;7:1-13.

5. Egbert PR, Fajardo LF, Donaldson SS, et al. Posterior ocular abnormalities after irradiation for retinoblastoma: a histopathological study. Br J Ophthalmol 1980;64:660-5.

6. Amoaku WM, Archer DB. Fluorescein angiographic features, natural course and treatment of radiation retinopathy. Eye (Lond) 1990;4:657-67.

7. Shields CL, Demirci H, Dai V, et al. Intravitreal triamcinolone acetonide for radiation maculopathy after plaque radiotherapy for choroidal melanoma. Retina 2005;25:868-74.

8. Sutter FK, Gillies MC. Intravitreal triamcinolone for radiation-induced macular edema. Arch Ophthalmol 2003;121:1491-3.

9. Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation of diabetic macular edema. Arch Ophthalmol 1985;103:1796-806.

10. Finger PT, Kurli M. Laser photocoagulation for radiation retinopathy after ophthalmic plaque radiation therapy. Br J Ophthalmol 2005;89:730-8.

11. Kinyoun JL. Long-term visual acuity results of treated and untreated radiation retinopathy (an AOS thesis). Trans Am Ophthalmol Soc 2008;106:325-35.

12. Finger PT, Chin K. Anti-vascular endothelial growth factor bevacizumab (avastin) for radiation retinopathy. Arch Ophthalmol 2007;125:751-6.

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

14. Finger PT, Chin KJ. Intravitreous ranibizumab (lucentis) for radiation maculopathy. Arch Ophthalmol 2010;128:249-52.

15. Dunavoelgyi R, Zehetmayer M, Simader C, et al. Rapid improvement of radiation-induced neovascular glaucoma and exudative retinal detachment after a single intravitreal ranibizumab injection. Clin Experiment Ophthalmol 2007;35:878-80.

16. Bakri SJ, Beer PM. Photodynamic therapy for maculopathy due to radiation retinopathy. Eye (Lond) 2005;19:795-9.

17. Lee SC, Song JH, Chung EJ, et al. Photodynamic therapy of subretinal neovascularization in radiation retinopathy. Eye (Lond) 2004;18:745-6.

18. Gall N, Leiba H, Handzel R, et al. Severe radiation retinopathy and optic neuropathy after brachytherapy for choroidal melanoma, treated by hyperbaric oxygen. Eye (Lond) 2007;21:1010-2.

19. Gupta P, Meisenberg B, Amin P, et al. Radiation retinopathy: the role of pentoxifylline. Retina 2001;21:545-7.

20. Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Survey of Ophthalmology 2010;55:108-33.

21. Shinomiya S, Naraba H, Ueno A, et al. Regulation of TNFalpha and interleukin-10 production by prostaglandins I(2) and E(2): studies with prostaglandin receptor-deficient mice and prostaglandin E-receptor subtype-selective synthetic agonists. Biochem Pharmacol 2001;61:1153-60.

22. Cheng T1, Cao W, Wen R, et al. Prostaglandin E2 induces vascular endothelial growth factor and basic fibroblast growth factor mRNA expression in cultured rat Müller cells. Invest Ophthalmol Vis Sci 1998;39:581-91.

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