Abstract
Clinical, pathological and experimental studies of radiation retinopathy confirm that the primary vascular event is endothelial cell loss and capillary closure. Pericytes are less susceptible, but typically atrophy as the capillaries become nonfunctional. The immediate effects of radiation reflect interphase and early mitotic death of injured endothelial cells, whereas later changes may be attributed to delayed mitotic death of compromised endothelial cells as they attempt division in the ordinary course of repair and replacement. Capillary occlusion leads to the formation of dilated capillary collaterals which may remain serviceable and competent for years. Microaneurysms develop in acellular and poorly supported capillaries, predominantly on the arterial side of the circulation and adjacent to regions of poorly perfused retina. Alterations in haemodynamics produce large telangiectatic-like channels which, typically develop a thick collagenous adventitia and may become fenestrated. Limited capillary regeneration occurs, usually evident as recanalisation of arterioles or venules by new capillaries. Vitreo-retinal neovascularisation may occur where retinal ischaemia is widespread. Radiation produces an exaggerated vasculopathy in patients with diabetes mellitus, and five month streptozotocin-induced diabetic rats develop a severe ischaemic retinopathy with vitreoretinal neovascularisation when exposed to 1500 cGy of radiation. Later photocoagulation is useful in containing or reversing microvascular incompetence and vasoproliferation in some patients with advanced radiation retinopathy.
Similar content being viewed by others
Article PDF
References
Moore RF : The value of radium in intraocular lesions. Trans Ophthalmol Soc UK 1935, 55: 3–26.
Stallard HB : Glioma retinae treated by radon seeds. Br Med J 1936, 11: 962–4.
Hayreh SS : Post-radiation retinopathy: A fluorescein fundus angiographic study. Br J Ophthalmol 1970, 74: 705–14.
Duke-Elder S and McFaul PA : Lesions caused by ionising radiation: Action on the uvea and retina. In System of Ophthalmology. Vol XIV Non-mechanical Injuries. Duke-Elder, S, Ed. Henry Kimpton London. 1972, 976–82.
de Schryver A, Wachmaster L, Baryd I : Ophthalmology observations on longterm survivors after radiotherapy for nasopharyngeal tumors. Acta Radiol Ther Phys Biol (Stockh) 1972, 10: 193–209.
Amoaku WMK and Archer DB : Cephalic Radiation and Retinal Vasculopathy. Eye 1990, 4: 195–203.
Merriam GRJ, Szechter A, Focht EF : The effects of ionising radiation on the eye. Front Radiation Ther ONC 1972, 6: 346–85.
Ehlers N and Kaae S : Effects of ionising radiation on retinoblastoma and on the normal ocular fundus in infants. A photographic and fluorescein angiographic study. Acta Ophthalmol (Suppl) 181 (Copenh) 1987, 65: 3–84.
Nakissa N, Rubin P, Strohl R, Keys H : Ocular and orbital complications following radiation therapy of paranasal sinus malignancies and review of literature. Cancer 1983, 51: 980–6.
Brown GC, Shields JA, Sanborn G, Augsburger JJ, Savino PJ, Schatz NJ : Radiation retinopathy. Ophthalmology 1982, 89: 1494–501.
Char DH, Lonn LI, Margolis LW : Complications of cobalt plaque therapy of choroidal melanomas. Am J Ophthalmol 1977, 84: 536–41.
Wara WM, Irvine AR, Neger RE, Howes EL, Phillips TL : Radiation retinopathy. Int J Radiat Oncol Biol Phys 1979, 5: 81–3.
Midena E, Segato T, Piermarocchi S, Corti L, Zorat PL, Moro F : Retinopathy following radiation therapy of paranasal sinus and nasopharyngeal carcinoma. Retina 1987, 7: 141–7.
Kinyoun JL, Kalina RE, Brower SA, Mills RP, Johnson RH : Radiation retinopathy after orbital irradiation for Graves' ophthalmopathy. Arch Ophthalmol 1984, 102: 1473–6.
Gass JDM : A fluorescein angiographie study of macular dysfunction secondary to retinal vascular disease. Arch Ophthalmol 1968, 80: 606–17.
Chee PHY : Radiation retinopathy. Am J Ophthalmol 1968, 66: 860–5.
Chaudhuri PR, Austin DJ, Rosenthal AR : Treatment of radiation retinopathy. Br J Ophthalmol 1981, 65: 623–5.
Parsons JT, Fitzgerald CR, Hood I, Ellingwood KE, Bova FJ, Million RR : The effects of irradiation on the eye and optic nerve. Int J Radiat Oncol Biol Phys 1983, 9: 609–22.
Amoaku WMK and Archer DB : Fluorescein angiographie features, natural course and treatment of radiation retinopathy. Eye 1990, 4 (in press).
Amoaku WMK : Thesis. The effects of ionizing radiation on the retina: A clinical and experimental study. Queen's University Belfast, June 1990.
Taniguchi Y : Ultrastructure of newly formed blood vessels in diabetic retinopathy. Jap J Ophthalmol 1976, 20: 19–31.
Wallow IHL and Gedler PS : Endothelial Fenestrae in Proliferative Diabetic Retinopathy. Invest Ophthalmol Vis Sci 1980, 19: 1176–83.
Archer DB : Retinal Neovascularization. Trans Ophthalmol Soc UK 1983, 103: 2–27.
Frank RN and Mancini MA : Presumed retinovitreal neovascularization in dystrophic retinas of spontaneously hypertensive rats. Invest Ophthalmol Vis Sci 1986, 27: 346–55.
Weber ML, Mancini MA, Frank RN : Retinovitreal Neovascularization in the Royal College of Surgeon Rat. Curr Eye Res 1989, 8: 61–74.
Archer DB and Gardiner TA : Morphologic, Flu-orescein angiographic and light microscopic features of experimental choroidal neovascularization. Am J Ophthalmol 1981, 91: 297–311.
Dhir SP, Joshi AV, Banerjee AK : Radiation retinopathy in diabetes mellitus. Acta Radial Oncol 1982, 21: 111–3.
Chan RC and Shukovsky LJ : Effects of irradiation on the eye. Radiology 1976, 120: 673–5.
Amoaku WMK, Frew L, Mahon GJ, Gardiner TA, Archer DB : Early ultrastructural changes after low-dose x-irradiation in the retina of the rat. Eye 1989, 3: 638–46.
Sharma NK, Archer DB, Gardiner TA : A morphologic and autoradiographic study of cell death and regeneration in the retinal microvasculature of normal and diabetic rats. Am J Ophthalmol 1985, 100: 51–60.
Reinhold HS : The influence of radiation on blood vessels and circulation. Chapter 2 Cell viability of the vessel wall. In Current Topics in Radiation Research Quarterly. North-Holland 1974: 9–28.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Archer, D., Amoaku, W. & Gardiner, T. Radiation retinopathy—Clinical, histopathological, ultrastructural and experimental correlations. Eye 5, 239–251 (1991). https://doi.org/10.1038/eye.1991.39
Issue Date:
DOI: https://doi.org/10.1038/eye.1991.39
This article is cited by
-
Early anti-VEGF treatment for radiation maculopathy and optic neuropathy: lessons learned
Eye (2023)
-
Evaluation of radiation maculopathy after treatment of choroidal melanoma with ruthenium-106 using optical coherence tomography angiography
BMC Ophthalmology (2021)
-
Treatment of radiation-induced maculopathy with fluocinolone acetonide
Graefe's Archive for Clinical and Experimental Ophthalmology (2020)
-
Evaluation of early changes of macular function and morphology by multifocal electroretinograms in patients with nasopharyngeal carcinoma after radiotherapy
Documenta Ophthalmologica (2019)
-
Intravitreal aflibercept for the treatment of radiation-induced macular edema after ruthenium 106 plaque radiotherapy for choroidal melanoma
Graefe's Archive for Clinical and Experimental Ophthalmology (2019)