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McCannel, Tara A., MD, PhD*; Kim, EunAh, MD*; Kamrava, Mitchell, MD; Lamb, James, PhD; Caprioli, Joseph, MD*; Yang, Dong, MD*; McCannel, Colin A., MD*

doi: 10.1097/IAE.0000000000001874
Original Study

Purpose: Radiation retinopathy remains incompletely characterized and may cause severe vision loss. Ultra–wide-field fluorescein angiography provides a pan-fundus view of vascular alterations caused by radiation treatment and may predict visual and ocular outcomes. We have developed a grading scheme to describe pan-fundus severity and to predict the progression of radiation retinopathy in patients treated for uveal melanoma with iodine-125 brachytherapy.

Methods: A retrospective review of patients treated with standard iodine-125 brachytherapy for uveal melanoma at the Ophthalmic Oncology Center at the University of California, Los Angeles, who had undergone both baseline and postbrachytherapy ultra–wide-field fluorescein angiography. A grading scheme was devised based on observations of vascular leakage, retinal perfusion status, and retinal proliferation. The correlation of grade severity with patient characteristics, tumor features, visual acuity, optical coherence tomography findings, and neovascular glaucoma was measured with chi-square and one-way analysis of variance analyses.

Results: Sixty-seven patients were identified for review. Consistent wide-field angiographic patterns after brachytherapy were observed and graded as follows: Grade 0: normal; Grade 1: late foveal leakage; Grade 2: late peripheral leakage; Grade 3: presence of nonperfusion; and Grade 4: retinal neovascularization. Six eyes (8.9%) were Grade 0; 16 (23.8%) were Grade 1; 25 (37.3%) were Grade 2; 16 (23.4%) were Grade 3; and 4 (6.0%) were Grade 4. Higher grade radiation severity correlated significantly with duration of follow-up (P < 0.02); younger age (P = 0.035); worse visual acuity (P = 0.001); cystoid macular edema or atrophy on optical coherence tomography (P < 0.0001); and neovascular glaucoma (P = 0.003).

Conclusion: Wide-field fluorescein angiography revealed distinct fundus-wide patterns of vascular damage, which were progressive in nature in eyes treated with iodine-125 brachytherapy for uveal melanoma and correlated with signs of progressive vascular injury. This grading scheme may have prognostic value to predict the progression of radiation retinopathy and to prognosticate visual outcomes in patients undergoing brachytherapy.

The authors report the characteristics and predictable findings associated with radiation retinopathy progression using the Optos ultra–wide-angle angiography system and devised a grading scheme that correlates with time from treatment, vision outcomes, and macular optical coherence tomography progression in radiation retinopathy. This grading scheme may be a useful tool to quantitate the benefits of potential strategies to improve vision in patients with uveal melanoma.

*Department of Ophthalmology, Stein Eye and Doheny Eye Institutes, University of California, Los Angeles, Los Angeles, California; and

Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, California.

Reprint requests: Tara A. McCannel, MD, PhD, 100 Stein PLZ, Los Angeles, CA 90095; e-mail:

Supported by the George E. and Ruth Moss Trust and unrestricted funds from Research to Prevent Blindness.

Paper presented at the Macula Society, Miami, FL, February 25, 2016.

None of the authors has any conflicting interests to disclose.

© 2018 by Ophthalmic Communications Society, Inc.