Blue-Light Fundus Autofluorescence Imaging following Ruthenium-106 Brachytherapy for Choroidal Melanoma

Abstract

To describe changes in blue-light fundus autofluorescence (FAF) and corresponding alterations in optical coherence tomography (OCT) within the irradiation field after ruthenium-106 brachytherapy (RBT) for choroidal melanoma. Methods: Consecutive patients with choroidal melanoma were included in a retrospective case series. Patients were treated with RBT at a single institution. As part of their routine examination patients underwent multimodal imaging including ultrasonography, fundus photography, OCT, and FAF imaging (excitation = 488 nm). FAF images were analysed for changes within the irradiation field. Results: 31 patients (mean age 65.7 years) were treated with RBT for unilateral choroidal melanoma. Mean tumour height before therapy was 2.7 mm (SD 1.0). Mean follow-up time was 23.3 months (SD 13.3). Main FAF characteristics attributable to RBT emerged as increased FAF with speckled decreased FAF (FAF mottling) within the irradiation field and a rim of increased FAF at its border. OCT scans demonstrated loss of the ellipsoid zone and the external limiting membrane, thinning of the neurosensory retina, and alterations of the retinal pigment epithelium like clumping, migration, and atrophy. Conclusions: FAF changes in the irradiation field after RBT of choroidal melanomas follow a characteristic pattern that correlates with distinct OCT alterations. FAF and OCT imaging give additional information to monitor effects of RBT and, therefore, complement multimodal imaging techniques after plaque therapy.

Fundus Autofluorescence Imaging in Patients with Choroidal Melanoma

“…Other reports underline the visualization of irradiation effects after plaque brachytherapy beyond ophthalmoscopically visible changes using FAF imaging [ 90 , 91 ]. In a retrospective study, both ruthenium-106 ( n = 19) and iodine-125 ( n = 2) plaque brachytherapy were found to induce a well-demarcated, increased FAF signal around the tumour in 69% of the eyes, detected by Optomap P200Tx (Optos, Dunfermline, UK) [ 90 ].…”

“…In a retrospective study, both ruthenium-106 ( n = 19) and iodine-125 ( n = 2) plaque brachytherapy were found to induce a well-demarcated, increased FAF signal around the tumour in 69% of the eyes, detected by Optomap P200Tx (Optos, Dunfermline, UK) [ 90 ]. Another retrospective case series ( n = 31) concretised the treatment effects of ruthenium-106 brachytherapy using confocal scanning laser FAF imaging and their correlation with optical coherence tomography (SPECTRALIS HRA + OCT, Heidelberg Engineering, Heidelberg, Germany) and fundus photography [ 91 ]. First, in 90.3% of the eyes, a rim of increased FAF demarcated the irradiation field of FAF and exceeded funduscopically visible changes ( Figure 5 ).…”

“…The fundus photograph was taken using FF 450 plus (Carl Zeiss Meditec AG, Jena, Germany); fundus autofluorescence and OCT: SPECTRALIS HRA+OCT, Heidelberg Engineering, Heidelberg, Germany). Reproduced from Bindewald-Wittich et al [ 91 ] with permission from S. Karger AG, Basel.…”

“…The fundus autofluorescence image was taken using SPECTRALIS HRA+OCT, Heidelberg Engineering, Heidelberg, Germany. Reproduced from Bindewald-Wittich et al [ 91 ] with permission from S. Karger AG, Basel.…”

Outcome Measures of New Technologies in Uveal Melanoma: Review from the European Vision Institute Special Interest Focus Group Meeting

“…Gregor Willerding reported on the scope of autofluorescence imaging (excitation wavelength 488 nm, detection of emission >500 nm) after ruthenium-106 brachytherapy for choroidal melanoma [60][61][62]. This imaging allows for visualization of autofluorescence originating from (melano-)lipofuscin at the level of the RPE as is shown in Figure 3.…”