Radiation Retinopathy After Brachytherapy for Choroidal Melanoma

Twelve to eighteen months following I125 brachytherapy for choroidal melanoma, radiation retinopathy and optic neuropathy can develop. The typical signs include intraretinal hemorrhages, cotton wool spots, macular edema, and optic disc edema. This fundus photograph shows all of these signs. The flat, slate gray, regressed choroidal melanoma is evident. Although the macular edema can be treated with intravitreal injections of bevacizumab or triamcinolone or with grid laser photocoagulation, the visual outcome is often poor because of capillary nonperfusion that accompanies the edema in many cases. Some patients develop retinal neovascularization, which can be treated with scatter laser photocoagulation.