Five-year treatment outcomes with 0.19 µg fluocinolone acetonide in radiation-induced maculopathy

Introduction: Chronic macular edema is a well-recognized complication of radiation-induced maculopathy (RM). Current treatment methods vary in efficacy and clinical benefit. The potential of fluocinolone acetonide (FAc) slow-release intravitreal implants (Iluvien® implant) remains unclear. We hypothesized that local continuous delivery of low-dose corticosteroids may improve RM symptoms. Methods: This study included eight patients who presented with RM after 106-Ru-plaque brachytherapy (n = 3), proton beam therapy (n = 2), or stereotactic radiation therapy (n = 3) with photons. All eyes were initially treated with triamcinolone injections but proved refractory to steroids. The Iluvien® implant was injected, and patients were followed to monitor clinical improvement. Results: After 5 years, visual acuity improved in three patients, remained stable in two patients, and decreased in two patients. One patient progressed to no light perception (NLP) following treatment. One patient was lost to follow-up after 5 years. Central macular thickness was reduced in five patients, stable in one patient, and increased in one patient. Discussion: Slow-release FAc implants are a promising treatment option to improve the anatomical structure of the fovea and visual function. They may also reduce the frequency of intravitreal injections and the overall therapeutic burden.