It has a half-life of 11.4 days with each decay, it emits four alpha-particles with high linear energy transfer of 27.4 MeV. At sites of active bone formation, Ra-223 is used in place of calcium as part of the calcium hydroxyapatite matrix. Īs an alkaline earth element, similar to calcium, Ra-223 accumulates in areas of increased bone remodeling. The use of Ra-223 has been shown to improve overall survival, bone pain, increase time to the first skeletal-related event, reduce rate of spinal cord compression, hospitalization, improve quality of life, and decrease the use of external beam radiation therapy. Radium-223 dichloride (Ra-223) is an alpha-emitting radionuclide, approved for treatment of osseous metastases in castrate-resistant prostate cancer, without known visceral metastases. The authors postulate that these ocular complications may be a result of radiation’s potential effect on neovascularization, polypharmacy, or the biomolecular effects of radium-223 on integral signaling proteins, potentially coupled with poor underlying ocular health. Conclusionsĭocumentation of adverse events is exceedingly important due to the high incidence of metastatic prostate cancer and increasing interest for the use of radium-223 in other osteoblastic disease. Ocular complications presented as blurry vision, and formal diagnosis included uveitis and hyphema. We present three cases of ocular complications after the use of radium-223 in patients with metastatic prostatic adenocarcinoma. Thus far, no ocular complication has been reported in the literature after initial administration of radium-223 with a single case reported of ocular complications after a patient’s second course of radium-223. It is well tolerated, with hematologic toxicity as the main adverse event. Radium-223 is used for the treatment of osseous metastases in castrate-resistant prostate cancer, and has been shown to increase time to the first skeletal-related event, reduce the rate of hospitalization, and improve quality of life.
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