The ABS-OOTF agreed (Level 2 Consensus) that intravitreal anti-VEGF therapy is useful to suppress radiation-induced neovascular glaucoma, radiation maculopathy, and optic neuropathy. Therapy is used to suppress transudation, thus ameliorate edema and counter neovascularization [119], [120], [121], [122] and [123]. However, although these techniques are widely used, the ABS-OOTF SCH772984 chemical structure recognizes that no published prospective randomized or large-scale studies examined the effects relative to initial radiation dose, dose rate, or source. The literature also contains two alternative approaches to the treatment of radiation

retinopathy. Laser photocoagulation in the form of posterior tumor demarcation resulted in sector devascularization best seen on fluorescein angiography. This technique along with sector pan retinal photocoagulation has been reported to slow or prevent radiation retinopathy by two independent centers [124] and [125]. Treatment converted slow ischemia within and anterior to the target to scar. In theory, laser devitalization of the ischemic tumor and treated retina may decrease

intraocular production of VEGF. However, brachytherapy also affects the eyelids, eyelashes, conjunctiva, tear production, corneal surface integrity, sclera, and ocular muscles [8], [100], [126] and [127]. Within the eye, radiation can cause iritis, uveitis, synechiae, CYC202 chemical structure neovascular glaucoma, cataract, posterior neovascularization, hemorrhage, retinal detachment, retinopathy, and optic neuropathy. The most common late sight

limiting posterior segment complication is radiation maculopathy. Unusual complications include persistent strabismus and scleral thinning. All the aforementioned side effects can result in loss of vision and quality of life. The ABS-OOTF recognize that there exists no comprehensive staging system for the ophthalmic side effects of radiation therapy. Although many of these findings are fundamentally, albeit less specifically, classified by the United States National Cancer Institute (Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 4.0, DCTD, National Cancer Institute, National Flavopiridol (Alvocidib) Institute of Health, Department of Health and Human Services (http://ctep.cancer.gov)), the ABS-OOTF recommends that a radiation-specific ophthalmic side effect staging system should be developed to improve communication for patient care, research, and publication. This presentation of ABS-OOTF guidelines for ophthalmic plaque brachytherapy offers both consensus and controversy. We recommend that brachytherapy should be performed by a team composed of a skilled subspecialty-trained plaque surgeon, radiation oncologists, and medical physicists in experienced subspecialty centers.