Radiation retinopathy masquerading diabetic retinopathy

Abstract

Background: Radiation retinopathy (RR) can occur years after irradiation as a chronic and progressive retinal micro-angiopathy. The presentations of RR are similar to other retinal vaso-occlusive disorders like diabetic retinopathy, hypertensive retinopathy. The patient was referred to us as a case of diabetic retinopathy who had received intravitreal injections for macular edema without any improvement. A thorough evaluation revealed it to be a case of Radiation retinopathy. RR treatment includes laser photocoagulation, intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, intravitreal steroid injections, and surgery. Case presentation: We report a case of a 47-year-old diabetic male patient in whom RR developed following 30Gy of radiation therapy for Ethmoidal sinus carcinoma masquerading as Diabetic retinopathy. FFA was showing extensive ischemia of the retina, and OCT showing Macular edema. He received Pan retinal photocoagulation in both eyes followed by multiple intravitreal Anti-VEGF injections on a PRN basis and underwent Pars plana vitrectomy in the right eye for non-resolving vitreous hemorrhage. Conclusion: The patient's vision improved only after treating the retinal ischemia with photocoagulation and later treating the macular edema. This report emphasizes the importance of differentiating this disease entity from other vaso-occlusive retinopathy by eliciting a detailed patient history and planning further management accordingly.