Radyasyonun Oküler Komplikasyonları
Özet
Radyoterapi (RT), intraoküler ve orbital tümörler ile belirli benign orbital hastalıkların tedavisinde göz ve görme fonksiyonunu koruma avantajı sunan kritik bir bileşendir. Ancak, gözün yüksek radyosensitivitesi nedeniyle tedavi sonrasında normal dokularda fonksiyon kayıpları ve çeşitli oküler komplikasyonlar gelişebilmektedir. Bu yan etkiler, ortaya çıkış zamanlarına göre akut (blefarit, konjonktivit, keratit) ve kalıcı vasküler hasara bağlı gelişen kronik geç etkiler (katarakt, kuru göz sendromu, retinopati ve optik nöropati) olarak sınıflandırılır. Özellikle posterior uveal melanom tedavisi sonrasında en sık görülen ve ciddi görme kaybına yol açan komplikasyonlar radyasyon retinopatisi ve radyasyona bağlı optik nöropatidir (RION). Toksisite riski; uygulanan toplam ve fraksiyon dozuna, hedef alanın büyüklüğüne ve lokalizasyonuna doğrudan bağlıdır. Bu komplikasyonların büyük oranda geri dönüşümsüz ve tedavi seçeneklerinin kısıtlı olması nedeniyle, risk altındaki organların tolerans doz limitlerinin altında tutulması, koruyucu gözlük/plak kullanımı ve tedavi portallarının hassas planlanması gibi önleyici stratejiler hayati önem taşımaktadır.
Radiotherapy (RT) is a critical component in treating intraocular and orbital tumors, as well as certain benign orbital diseases, offering the advantage of preserving the eye and visual function. However, due to the high radiosensitivity of the eye, treatment can lead to functional loss in normal tissues and various ocular complications. These side effects are classified as acute (blepharitis, conjunctivitis, keratitis) or chronic late effects (cataract, dry eye syndrome, retinopathy, and optic neuropathy) resulting from permanent vascular damage. Particularly following the treatment of posterior uveal melanoma, radiation retinopathy and radiation-induced optic neuropathy (RION) are the leading causes of severe, permanent visual impairment. The risk of toxicity is directly related to the total radiation dose, fraction dose, and the size and location of the target area. Since these complications are largely irreversible and treatment options remain limited, preventive strategies—such as keeping radiation doses below defined tolerance limits for organs at risk, using protective glasses or plaques, and meticulous treatment planning—are of vital importance.
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