Neuroretinal Imaging Inflammatory Biomarkers Anticipating Radiation-Induced Macular Edema.

A 59-year-old woman underwent iodine-125 brachytherapy (85 Gy at tumor apex; dose rate 0.74 Gy/hour) in her left eye for a peripheral uveal melanoma. Spectral domain optical coherence tomography was prospectively performed (Heidelberg Engineering, Heidelberg, Germany). The analysis of the macular area at baseline (A) (before brachytherapy) shows a normal macula appearance. At 6-month follow-up (B), spectral domain optical coherence tomography shows the appearance of numerous hyperreflective retinal spots, with a conserved macular profile, indicating, according to the current literature, the presence of microglial activation and preclinical neuroretinal inflammation, without evidence of macular edema.1–3 Two months later (C), spectral domain optical coherence tomography shows a further increase in the number of hyperreflective retinal spots and the appearance of cystoid macular edema, with limited subfoveal neuroretinal detachment (Figure 1). As previously reported, hyperreflective retinal spots increase in number with increasing central subfield thickness and could be considered as a new clinical biomarker of intraretinal inflammation in patients affected by macular edema secondary to irradiation.2 See Figure, Supplemental Digital Content 1, http://links.lww.com/IAE/B105, which shows the absence of significant macular edema at the macular map and no evidence of radiationinduced chorioretinopathy at the infrared image of the posterior pole at baseline and at 6-month followFig. 1. A. Macular optical coherence tomography linear scan in a patient affected by uveal melanoma before treatment. B. Macular optical coherence tomography linear scan performed in the follow-up modality 6 months after iodine-125 brachytherapy in the same patient, showing the appearance of numerous hyperreflective intraretinal spots (the yellow arrows point to some of them). C. Macular optical coherence tomography follow-up scan, performed 2 months later, showing an increased number of hyperreflective intraretinal spots, and the appearance of cystoid macular edema with limited subfoveal neuroretinal detachment secondary to radiation maculopathy (the yellow arrows point to some of them).