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Small Case Series | Nov 2012

Response to Ranibizumab Following Tachyphylaxis to Bevacizumab in a Patient With Radiation Maculopathy Following Stereotactic Fractionated Radiotherapy for Optic Nerve Meningioma

Gurjeet Jutley, BM, BSc(Hons); Olajumoke A. Shona, FWACS, FRCS; Richard Cheong Leen, MSc, MRCOphth; Nicholas Lee, FRCOphth; Jane M. Olver, FRCOphth; Sheena M. George, FRCOphth

Arch Ophthalmol. 2012;130(11):1466-1470. doi:10.1001/archophthalmol.2012.1542.

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A 38-year-old man presented to our eye clinic 21 months after radiotherapy for optic nerve meningioma in the left eye. At initial assessment, he had a visual acuity (VA) of 6/36, a central retinal thickness of 531 μm, and minimal disruption of the foveal avascular zone. The decision was made to treat his condition with intravitreal injections of bevacizumab (Avastin; Roche). His left eye's initial response to bevacizumab was very encouraging, with VA improving to 6/12 after 3 injections. However, this response was transient; after 6 injections, he had a VA of 6/18 and a central retinal thickness of 475 μm in the left eye. His treatment was then switched to intravitreal injections of ranibizumab (Lucentis; Novartis), and he experienced a complete resolution of his cystoid macula edema, with a final VA of 6/6 and a central retinal thickness of 264 μm in the left eye. This is an interesting case of tachyphylaxis to bevacizumab in a patient with radiation maculopathy, with full resolution following intravitreal injections of ranibizumab.

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Figure 1. Optical coherence tomographic scan of left eye of patient showing intraretinal edema and multiple intraretinal cysts (asterisks) prior to bevacizumab treatment. N indicates nasal; T, temporal.

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Figure 2. A, Fundus color photograph showing retinal hemorrhages (black arrowheads) and multiple cotton-wool spots (white arrowheads) before treatment with bevacizumab. B, Fundus fluorescein angiogram at the midvenous phase showing enlarged fovea avascular zone (white arrows) before treatment with bevacizumab. C, Fundus fluorescein angiogram at late venous phase showing macula edema with leakage of dye (white arrowheads) and retinal neovascularization (black arrowhead).

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Figure 3. Optical coherence tomographic scan of left eye of patient showing increased intraretinal edema after 6 months of consecutive injections of bevacizumab. N indicates nasal; T, temporal.

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Figure 4. Optical coherence tomographic scan of left eye of patient showing complete resolution of intraretinal edema after 7 intravitreal injections of ranibizumab. N indicates nasal; T, temporal.

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Figure 5. Fundus color photograph showing resolution of cotton-wool spots and retinal hemorrhage after ranibizumab therapy.

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Jutley G, Shona OA, Leen R, Lee N, Olver JM, George SM. Response to Ranibizumab Following Tachyphylaxis to Bevacizumab in a Patient With Radiation Maculopathy Following Stereotactic Fractionated Radiotherapy for Optic Nerve Meningioma. Arch Ophthalmol. 2012;130(11):1466-1470. doi:10.1001/archophthalmol.2012.1542.

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