COMPARISON BETWEEN SCLERAL BUCKLING AND VITRECTOMY IN THE ONSET OF CYSTOID MACULAR EDEMA AND EPIRETINAL MEMBRANE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

PURPOSE: To investigate the incidence and risk factors for the main complications in patients with rhegmatogenous retinal detachment treated with scleral buckling (SB) or pars plana vitrectomy (PPV). METHODS: A retrospective, comparative, observational study was conducted. The medical records of 107 patients with primary rhegmatogenous retinal detachment who were managed with SB (n = 57) or PPV (n = 50) were reviewed. Scleral buckling was performed using scleral encircling solid silicone band and circumferential solid silicone exoplant to support the break. Pars plana vitrectomy was combined with phacoemulsification in phakic eyes and with scleral encircling in inferior detachments. Follow-ups, including spectral-domain optical coherence tomography examination, were scheduled at 1, 3, and 12 months after surgery. Propensity score matching was used to adjust for potential preoperative selection bias. RESULTS: The overall incidence of postoperative cystoid macular edema (CME) and epiretinal membrane was 14.95% and 30.84%, respectively. Compared with SB, CME was more frequent in the PPV (P = 0.021) and in the PPV pseudophakic eyes (P = 0.027). Postoperative CME was an early, predominantly transient complication and regressed in 67% of SB and in 77% of PPV eyes within 12 months after surgery. No differences were observed regarding epiretinal membrane development. Except for the surgical technique, no preoperative factors associated with CME were identified. A correlation between epiretinal membrane and patients' age was found (P = 0.028). CONCLUSION: The incidence of CME after rhegmatogenous retinal detachment repair was higher in patients who underwent PPV, either alone or combined with phacoemulsification, than in those treated with SB. Epiretinal membrane development was correlated to older age, regardless of the surgical procedure.

Association of periodontitis and diabetic macular edema in various stages of diabetic retinopathy.

OBJECTIVES: Periodontitis and diabetes are known to have a bidirectional relationship. Diabetic macular edema is a complication of diabetes that is strongly influenced by inflammatory pathways. However, it remains to be established whether inflammation at other locations, such as periodontitis, affects diabetic macular edema. Here, we investigated the prevalence of periodontitis in patients treated for diabetic macular edema. MATERIALS AND METHODS: Patients with diabetic macular edema were recruited for this cross-sectional study at the Medical University of Graz. Macular edema was documented by optical coherence tomography. Periodontal status was assessed by computerized periodontal probing and panoramic X-ray imaging. Bleeding on probing, clinical attachment level, probing pocket depth, and plaque index were compared between different stages of diabetic retinopathy. RESULTS: Eighty-three eyes of 45 patients with diabetic macular edema were enrolled. Forty-four eyes (53.0%) had early stages of diabetic retinopathy (mild and moderate), and 39 eyes (47.0%) had late stages (severe and proliferative). Patients with mild or moderate DR were more likely to have more severe periodontal conditions than patients with severe or proliferative DR. Fourteen patients with mild DR (82.4%), 7 patients with moderate DR (87.5%), 4 patients with severe DR (100.0%), and 15 patients with proliferative DR (93.8%) had some degree of PD. The periodontal inflamed surface areas and the percentages of tooth sites that bled on probing were significantly higher in patients with early stages of diabetic retinopathy than in those with late stages of the disease (p < 0.05). Patients with periodontal inflamed surface areas of more than 500 mm2 required significantly more intravitreal injections in the last year than those with milder forms of periodontitis (n = 6.9 ± 3.1 versus n = 5.0 ± 3.5, p = 0.03). CONCLUSION: In patients with diabetic macular edema, periodontitis is more prevalent in early stages of diabetic retinopathy. We suggest regular dental check-ups for diabetic patients, especially when diabetic macular edema is already present. CLINICAL RELEVANCE: Patients with diabetic macular edema should be screened for periodontitis and vice versa, particularly early in the course of diabetes.

CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS.

PURPOSE: To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage. METHODS: Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B). RESULTS: Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory). CONCLUSION: In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.

Effect of Repeated Topical Povidone-Iodine and Antibiotic Applications on Meibomian Glands and Ocular Surface Parameters in Patients With Repeated Intravitreal Injections.

OBJECTIVES: To assess whether meibomian glands and ocular surface parameters are affected by repeated topical povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. METHODS: Forty-five patients with at least three previous intravitreal injections and 28 healthy controls were included in the study. In the injection group, 21 patients had age-related macular degeneration and 24 patients had diabetic macular edema. For each participant, infrared meibography for the upper and lower eyelids and noninvasive tear break-up time calculation were performed with a corneal topographer. Fluorescein tear break-up time and ocular surface disease index (OSDI) scores were also obtained. Noninvasive tear break-up time, fluorescein tear break-up time, and OSDI scores were recorded for each participant and compared between the injection and control groups. These parameters were also compared as a subgroup analysis between patients with age-related macular degeneration (AMD) and diabetic macular edema (DME). RESULTS: Upper lid meibomian gland loss, lower lid meibomian gland loss ratios, and OSDI scores were significantly higher in the intravitreal injection group compared with the control group (P=0.004, P<0.001, P<0.001, respectively). Fluorescein tear break-up time and noninvasive tear break-up time were significantly lower in the intravitreal injection group compared with the control group (P<0.001, P<0.001). There was no significant difference between the AMD and DME groups for these parameters. CONCLUSION: This study showed for the first time that meibomian gland losses were significantly increased by repeated povidone-iodine and antibiotic applications in patients with repeated intravitreal injections. Ocular surface parameters were altered with higher ocular surface symptoms in those patients.

Development of cystoid macular edema after uneventful cataract surgery in eyes with a history of vitrectomy using silicone oil versus gas tamponade.

BACKGROUND/OBJECTIVES: The purpose of this study is to investigate whether history of silicone oil tamponade may predispose to the development of cystoid macular edema (CMO) following uneventful post-vitrectomy cataract surgery. SUBJECTS/METHODS: This is a retrospective study that was conducted at a single academic institution. Records of patients who underwent pars plana vitrectomy (PPV) with or without silicone oil tamponade and subsequent cataract surgery between 2017-2020 were reviewed. Macular optical coherence tomography (OCT) findings up to 4 years after surgery were assessed. RESULTS: A total of 95 eyes were included. Forty-one eyes underwent cataract surgery and had a history of PPV with silicone oil tamponade (Group 1). Fifty-four eyes underwent cataract surgery by phacoemulsification and had a history of PPV with gas tamponade (Group 2). Average follow up time after cataract surgery was 41.1 months. In Group 1, the incidence of OCT-detected CMO was 39.0%, compared to 27.8% in Group 2 (p = 0.247). The incidence of clinically significant CMO in Group 1 was 22.0%, compared to 18.5% in Group 2 (p = 0.679). The duration of CMO was significantly longer in Group 1 (p = 0.041) and cases were less likely to resolve by the last follow up visit (p = 0.040). CONCLUSIONS: The incidence of OCT-detected or clinically significant pseudophakic CMO is not significantly different between eyes with prior PPV with gas tamponade versus silicone oil tamponade. However, CMO after uneventful cataract surgery may have a prolonged course if there is history of silicone oil tamponade, requiring longer treatment.

Long-term complications according to silicone oil type. A single center cohort study.

PURPOSE: To study the incidence of macular edema (ME), ocular hypertension (OHT), emulsification and migration to the anterior chamber (AC) of silicone oil (SO) in patients after complex retina surgery, stratified by SO type. METHODS: Retrospective, cohort study. Patients who underwent retina surgery with SO injection and extraction in our center were included. We compared the complication rates of ME, OHT, emulsification and migration to the AS according to SO type (1300cSt, 5700cSt and heavy SO). Data on age, sex, emulsification time, duration of the tamponade, previous retina surgeries and diagnosis were also gathered and included in a multivariate analysis. RESULTS: We included 163 patients (mean age of 64.8 years; mean duration of the tamponade: 11 months). Rates of emulsification, ME, OHT and SO migration to the AC were similar in all groups (p = 0.998, 0.668, 0.915 and 0.360). ME was the most frequent complication (33.3-47.8%), which resolved after SO extraction in 77.6% of cases. The majority of cases with OHT persisted (61.7%). Emulsification was related to younger age (OR 0.94) and longer duration of the tamponade (OR 1.04). The odds of SO migration to the AC increased with emulsification (OR 2.78), recurrent retinal detachment (OR 0.99) and aphakia (OR 4.05). CONCLUSIONS: We propose SO extraction as the preferred treatment for ME during SO tamponade. SO extraction should be performed sooner in younger patients to avoid emulsification. In selected patients, we suggest a longer duration of the tamponade up to 11 months with a reasonable safety profile, regardless of the SO type.

Macular edema after surgery to treat rhegmatogenous retinal detachment: 1-year follow-up, incidence, and associated risk factors.

PURPOSE: To clarify the postoperative incidence of macular edema in patients undergoing surgery to repair rhegmatogenous retinal detachment and identify the associated risk factors. METHODS: In this prospective, observational study, 79 patients who underwent surgery to correct rhegmatogenous retinal detachment using pars plana vitrectomy with silicone oil injection were analyzed. Patients were followed up postoperatively at 7, 30, 90, 180, and 365 days. At each visit, optical coherence tomography was performed to assess the presence or absence of macular edema. were analyzed as possible risk factors for macular edema: age, sex, macular status (attached or detached), presence of vitreoretinal proliferation, history of previous intraocular surgery, reported time of symptoms suggestive of rhegmatogenous retinal detachment up to the date of surgery, and the surgical modality performed. RESULTS: The 1-year macular edema prevalence rate was 26.6%. In the adjusted analysis, older patients had a higher risk of macular edema, and each 1-year increase in age increased the risk of macular edema by 6% (95% confidence interval = 1.00-1.12). The macular status, vitreoretinal proliferation, the surgical technique used, prior intraocular surgery, and the intraocular lens status were not identified as risk factors. However, the incidence of macular edema increased up to 180 days after surgery, peaking at 10.6%, and then decreased until 365 days after surgery. CONCLUSION: Macular edema was a common complication after surgery to treat rhegmatogenous retinal detachment, with its incidence peaking between 30 and 180 days after surgery. Age was an important risk factor for macular edema in this cohort.

Inflammation and macular oedema after pars plana vitrectomy.

Cystoid macular oedema (CMO) is a major cause of reduced vision following intraocular surgery. Although the aetiology of CMO is not completely clarified, intraocular inflammation is known to play a major role in its development. The macula may develop cytotoxic oedema when the primary lesion and fluid accumulation occur in the parenchymatous cells (intracellular oedema) or vasogenic oedema when the primary defect occurs in the blood-retinal barrier and leads to extracellular fluid accumulation (extracellular oedema). We report on the mechanisms of CMO formation after pars plana vitrectomy and associated surgical procedures and discuss possible therapeutic approaches.

Single-dose Effect of Intravitreal Dexamethasone Implant for Post-vitrectomy Macular Edema under Silicone Oil.

PURPOSE: To investigate the single-dose effect of intravitreal dexamethasone (DEX) implant for patients with post-vitrectomy macular edema (ME) under silicone oil (SO) tamponade. METHODS: Twelve eyes diagnosed with ME after undergoing pars plana vitrectomy with SO injections were retrospectively reviewed. Each eye received a single intravitreal DEX implant (0.7-mg, Ozurdex; Allergan Inc) injection as treatment for recalcitrant ME. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were recorded. RESULTS: Compared with baseline (1.24 ± 0.34), the mean LogMAR BCVA improved at 1 (1.14 ± 0.27), 3 (1.13 ± 0.22), and 6 (1.22 ± 0.30) months without statistical significance. Maximal CMT resolution was observed at 1 month after intravitreal injection. The CMT value improved significantly at 1 (P = .008), 3 (P = .006), and 6 (P = .009) months. IOP did not show significant elevation during follow-up. No serious adverse events were observed. CONCLUSION: Single-dose treatment of DEX implant may have benefit for recalcitrant post-vitrectomy ME under SO tamponade.

Efficacy of Pegylated Interferon Alpha-2a in Uveitic Macular Edema Refractory to Biologic Agents.

PURPOSE: To report the efficacy of pegylated interferon alpha-2a (Roferon, Hoffmann-La Roche brands, Switzerland) in uveitic macular edema refractory to biologic agents. METHODS: Herein, we present two cases of non-infectious uveitis with cystoid macular edema (CME) who were unresponsive to immunosuppressant treatment, and whose uveitis and macular edema recurrences were prevented with subcutaneous injections of pegylated interferon α-2a. RESULTS: Two young males (27- and 30-year-old) diagnosed with non-infectious uveitis and CME were on immunosuppressive treatment. Although both received systemic steroids and biologic agents, macular edema persists. After initiation of pegylated interferon alpha-2a (Pegasys, Genentech, USA) CME regressed significantly and did not occur during their follow-ups of 14 and 12 months. CONCLUSION: Pegylated interferon-alpha-2a can be used as an effective alternative to interferon alpha-2a in uveitic macular edema cases, resistant to other immunosuppressive agents.

BEVACIZUMAB FOR POST VITRECTOMY CYSTOID MACULAR EDEMA IN A SILICONE OIL-FILLED EYE.

PURPOSE: To report the safety and efficacy of intravitreal bevacizumab (IVB) in a case of cystoid macular edema (CME) in a silicone oil-filled eye. METHODS: A man, aged 51 years, reported with poor visual improvement in the right eye (RE) after pars plana vitrectomy with oil injection performed 2 months back for a pseudophakic, macula-off rhegmatogenous retinal detachment. His best-corrected visual acuity in the RE was counting fingers 2 m. Fundus examination of the RE showed a silicone oil-filled eye with attached retina, and CME was confirmed on spectral-domain optical coherence tomography. He was advised to undergo IVB injection, which was given a few days later. RESULTS: One week after IVB, the central macular thickness had decreased to 437 µ m. Seven weeks later, the macular edema subsided completely with a final central macular thickness of 219 µ m. His vision improved by seven lines to 6/24 and was stable for another 2 months. He underwent removal of silicone oil after 3 months, wherein his visual acuity improved further by one line to 6/18. DISCUSSION: This case demonstrates the use IVB for CME in a silicone oil-filled eye. It was found that IVB was safe and effective in CME associated with a silicone oil-filled eye.

The effect of recurrent povidone-iodine usage on conjunctival flora in diabetic patients undergoing intravitreal injections.

PURPOSE: The purpose was to evaluate the change in the microbiological profile of diabetic patients undergoing intravitreal injections for diabetic macular edema. METHODS: Patients were included in this prospective study when referred for the first time for intravitreal injection to treat diabetic macular edema. For each patient, conjunctival cultures were taken from the lower fornix of each eye prior to the povidone-iodine application and the intravitreal injection. An additional culture was taken from the treated eye 20 min after the injection. The same culture protocol was used for the two following injections of these patients. A later conjunctival culture was also taken a month after the last injection. RESULTS: Twenty-one eyes of 21 patients were included. The mean duration of diabetes was 13.7 ± 7.9 years. Prior to the first intravitreal injection, 33% of cultures were positive. Prior to the third intravitreal injection, 26% of cultures were positive (p = 0.63), and 1 month after the last injection, 18% of cultures were positive (p = 0.495). The mean HbA1C was 8.1% ± 1.7%. HbA1C of patients with positive cultures was 8.0% ± 1.1% at the first intravitreal injection and 8.2% ± 1.0% at the third intravitreal injection. This was compared with HBA1C in eyes with negative cultures: 7.4% ± 1.2% (p = 0.45) and 7.1% ± 1.0% (p = 0.14), respectively. CONCLUSION: Repeated intravitreal injection for diabetic macular edema with application of povidone-iodine 5% in diabetic patients did not lead to a significant change in the percentage of positive conjunctival cultures. Patients with higher HbA1C had a slight, non-statistically significant trend for positive cultures.

Efficacy and Safety of Interferon Alpha 2A and Pegylated Interferon Alpha 2A in Inflammatory Macular Edema.

Purpose: The aim of this study was to further explore the efficacy and safety of interferon-α in refractory non-infectious inflammatory macular edema and to compare interferon-α2a and pegylated interferon-α2b.Methods: 34 patients with refractory non-infectious uveitic macular edemaunder interferon-α were retrospectively reviewed.Results: Mean baseline best-corrected visual acuityimproved from 0.55 logMar to 0.37 logMAR (P < 0.001) at month (M) 1 and 0.40 logMAR (P < 0.001) at M6. The mean baseline CMT decreased from 554 µm to 367 µm (P < 0.001) at M1 and 394 µm (P < 0.001) at M6. Clinical adverse effects (AEs) were observed in a third of patients, leading to treatment discontinuation because of frequent mild AEs and few severe AE. No statistically significant difference was found between both molecules.Conclusions: Anatomically and functionally, interferon-α was rapidly effective despite a low dosage regimen and no difference in efficacy and tolerance was observed between interferon-α2a and pegylated interferon-α2b.

RECURRENT OPENING AND CLOSURE OF MACULAR HOLE AFTER PARS PLANA VITRECTOMY FOR RHEGMATOGENOUS RETINAL DETACHMENT.

PURPOSE: To report a case of full-thickness macular hole formation and closure twice after pars plana vitrectomy for macula-off rhegmatogenous retinal detachment. METHODS: Case report. RESULTS: A 45-year-old woman with a macula-off rhegmatogenous retinal detachment underwent uncomplicated pars plana vitrectomy with silicone oil tamponade, which was removed 3 months postoperatively. A full-thickness macular hole developed spontaneously 18 months after silicone oil removal, concurrently with the formation of epiretinal membrane and perifoveal cystoid changes. The hole was noted to close spontaneously within 2 months with normal foveal contour formation and improved vision, but then reopened for the second time after 10 months. A second spontaneous closure was observed within 2 months. CONCLUSION: Dynamic course of macular hole formation and resolution in a previously vitrectomized eye may justify a more conservative approach with observation for some time before surgical intervention is favored.

Fracture of a polyimide-elastimide posterior chamber intraocular lens following blunt orbital trauma.

PURPOSE: Fracture of a three-piece polyimide-elastimide intraocular lens at the optic-haptic junction following blunt trauma is a possible complication after cataract surgery. We report a case of an isolated posterior chamber intraocular lens fracture caused by direct ocular blunt trauma. CASE: A 51-year-old patient underwent blunt orbital trauma caused by a raw chicken egg that was thrown at him, as he was walking. The posterior chamber intraocular lens was found in the anterior chamber, with a broken optic-haptic junction. The intraocular lens was exchanged, followed by iris fixation and pupilloplasty, with satisfactory postoperative anatomical and optical outcomes. DISCUSSION: The three-piece polyimide-elastimide intraocular lens was fractured at the optic-haptic junction. Although the fractured intraocular lens surface had a regular appearance, it has been previously reported that the polyimide haptic's durability is probably inferior to that of polymethylmethacrylate. Therefore, it is highly susceptible to shear stress induced by a blunt trauma. CONCLUSION: To our knowledge, this is an uncommon report of an implanted posterior chamber polyimide-elastimide intraocular lens fracture following blunt orbital trauma. Intraocular lens exchange and fixation had successful optical and anatomical results.

Topical Triamcinolone Acetonide-Loaded Liposomes as Primary Therapy for Macular Edema Secondary to Branch Retinal Vein Occlusion: A Pilot Study.

Purpose: To explore safety and therapeutic efficacy of a topical ophthalmic triamcinolone acetonide-loaded liposome formulation (TA-LF) as primary therapy in patients with macular edema (ME) secondary to branch retinal vein occlusion (BRVO). Methods: Twelve eyes of 12 patients with ME secondary to BRVO were exposed to a topical instillation of 1 drop of TA-LF (TA 0.2%) 6 times a day for 12 weeks to evaluate safety and efficacy. Best corrected visual acuity (BCVA) intraocular pressure (IOP), slit lamp examination, and central foveal thickness (CFT) were analyzed at every visit. In addition, the morphology of TA-LF was analyzed using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Results: Patients presented a significant improvement of BCVA and CFT without significant IOP modification (P = 0.94). Treated eyes showed BCVA improvement from 40 ± 12.05 to 64.83 ± 15.97 letters and CFT reduction from 682.91 ± 278.60 to 271.58 ± 57.66 µm after 12 weeks of TA-LF therapy (P < 0.001). No adverse events, including IOP rising, were registered. SEM analysis of liposomal formulations showed that liposome (LP) size depends on its concentration. As the concentration of TA increased, the average size of LPs and the number of larger particles increased as well. TEM study displayed that LP formulation efficiently solubilizes TA crystals in nanoparticles and encapsulates them. Conclusion: LPs can function as nanocarriers of TA and they could be used as topical ophthalmic primary therapy instead of intravitreal drugs in patients with ME secondary to BRVO.

Lessons of the month 2: A case of Behçet's disease: 70% have ophthalmic involvement.

A 34-year-old man presented to the emergency department with acute painless loss of vision of the left eye. Past medical history included painful lumps in the legs and frequent mouth ulcers, which were undiagnosed. The patient's visual acuity was 6/5 and counting fingers in the right and left eye, respectively. There were extensive intraretinal haemorrhages and venous sheathing in the superior quadrant of the left eye with associated disc oedema. The case was discussed in a multidisciplinary team meeting in the presence of ophthalmology, dermatology and immunology and a diagnosis of Behçet's disease was reached. The patient was commenced on intravenous methylprednisolone for 3 days followed by a switch to oral prednisolone. Due to recalcitrant uveitis, an intravitreal dexamethasone implant was administered. Eventually, systemic azathioprine and infliximab were commenced with frequent review by ophthalmology and immunology. The macular oedema improved but, unfortunately, the patient's visual acuity did not recover. Behçet's disease is a complex vasculitis involving multiple organ systems. Ocular manifestations can occur in 70% of patients, comprising retinal vasculitis, anterior uveitis, iridocyclitis, chorioretinitis, scleritis, keratitis, vitreous haemorrhage, optic neuritis, conjunctivitis, retinal vein occlusion and retinal neovascularisation. A tailored multidisciplinary approach is required, with corticosteroids being the mainstay of treatment.

Dental inflammation and central retinitis--it is important to protect the retina from the harmful sunlight.

During 3-year study of 73 patients with dental inflammation, sinusitis, otitis and 5 cases with granuloma, in 9 cases we observed the development of central retinitis. All patients were medicated with the same antibiotics and parabulbar depo of Prednisolonacetate. To 50% of these patients, we suggested eye protection with Yellow Medical filters during two months. In the first group with medication we observed better vision in 69%, but in the second group with eye protection with Yellow Medical filters we observed normalization of vision in 100%.

Radiation retinopathy secondary to treatment of maxillary sinus carcinoma: a dramatic case. / Retinopatía por radiación secundaria a tratamiento de carcinoma de seno maxilar: un caso dramático.

CLINICAL CASE: A 53-year old male presented with visual impairment in right eye after irradiation of right maxillary sinus carcinoma. Funduscopy shows radiation retinopathy: haemorrhages, exudates, macular oedema, and peripheral retinal ischaemia. A poor outcome was achieved despite laser treatment and intravitreal injections of bevacizumab, resulting in evisceration of the affected eye. DISCUSSION: Radiation retinopathy must be considered in any loss of vision after head and neck irradiation. Ophthalmological long-term follow-up of these patients is essential for an early diagnosis.