Patients who have had treatment for a choroidal melanoma with radiation plaque brachytherapy will sometimes go on to develop retinal problems secondary to the radiation exposure which was needed to sterilize their tumor. This is called radiation retinopathy. These retinal problems can manifest as an increased thickness of the retina and/or intraretinal and subretinal fluid (fluid inside the retina and underneath the retina, respectively). If left untreated, this can lead to permanent loss of vision.
Fortunately, Dr. Finger had discovered that radiation retinopathy is treatable with periodic injections into the eye of anti-VEGF drugs, such as Avastin, Eylea, and Lucentis. These eye injections are already very commonly used to treat eye conditions, such as neovascular (“wet”) macular degeneration. In fact, the administration of these eye injections is now the most common surgical procedure in the United States.
There is now a new anti-VEGF drug called brolucizumab, also known as RTH258, which is currently in Phase III clinical trials. This novel drug is a tiny humanized single-chain antibody fragment. This type of fragment is thought to have improved tissue penetration, and therefore, improved drug delivery due to its small size. Trials thus far have shown brolucizumab to be superior in the treatment of wet macular degeneration, compared to Eylea. Patients presented with decreased retinal thickness, intraretinal fluid, and subretinal fluid — the same signs we treat in radiation retinopathy at The New York Eye Cancer Center! Interestingly, patients maintained these improved results even with a longer dosing interval of every 12 weeks. Most importantly, potential adverse reactions were comparable in both the brolucizumab and Eylea groups. Pending the results of more trials and FDA approval, this drug may be available for use in 2019.
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