This 52YO female presented on 1/19/23 with a history of metastatic breast cancer and an asymptomatic uveal metastasis in her right eye. The lesion completely regressed following external beam radiation.
When examined on 12/19/24, she remained visually asymptomatic with 20/60 vision. Color photography shows a new, mildly swollen nerve, which is confirmed on OCT. Scattered nerve fiber layer infarcts (cotton-wool spots, CWS) and some nasal macular telangiectasia are also noted.
Learning Points:
Radiation retinopathy usually occurs 3 months to 3 years after external-beam radiation or plaque radiotherapy. The ocular findings closely resemble those seen with diabetic retinopathy. Radiation optic neuropathy (Carey et al, Br J Ophthalmol 2023;107:743-749) can also develop.
Since our patient was completely asymptomatic without macular edema, we recommended close observation. We will begin intravitreal anti-VEGF therapy if she develops macular edema or worsening nerve findings.
