Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

Shields, Carol L.; Say, Emil Anthony T.; Samara, Wasim A.; Khoo, Chloe T.L.; Mashayekhi, Arman; Shields, Jerry A.

doi:10.1097/iae.0000000000001021

Cited by 78 publications

(84 citation statements)

References 31 publications

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“…Noticeably, an observer-dependent grading of capillary network integrity was correlated to these morphologic parameters, illustrating the relevance of a clinical grading system based on OCTA in radiation maculopathy, as previously proposed. 15 Although no study has yet compared vascular changes on OCTA following brachytherapy and proton-beam irradiation, a qualitative comparison of our findings with the detailed characteristics reported by Shields et al 14 shows a comparable FAZ enlargement (1.12 vs. 1.25 mm 2 ), after similar mean duration since irradiation (45.1 vs. 46 months). Authors have also reported vascular densities based on a custom method before it became standardized in OCTA devices, which prevents reliable comparison.…”

Section: Discussionsupporting

confidence: 66%

“…After plaque brachytherapy, Veverka et al 15 describe gradual alterations of the macular microvasculature on OCTA. Shields et al 14 have reported a decreased capillary density in both plexuses, as well as FAZ enlargement. Finally, Say et al 25 have reported decreased capillary density in irradiated eyes without clinically patent maculopathy.…”

Section: Discussionmentioning

confidence: 93%

“…13 Ocular irradiation by I-125 plaque brachytherapy induces microvascular changes detected by OCTA. 14,15 However, the consequences of proton-beam therapy, a major treatment modality for uveal melanoma, have not been assessed by OCTA. In this study, we investigated the spectrum of structural and microvascular alterations in radiation maculopathy after proton-beam therapy for uveal melanoma, and their respective influence on visual acuity, using OCT and OCTA.…”

mentioning

confidence: 99%

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Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Matet

Daruich

Zografos

2017

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. To analyze microvascular and structural changes in radiation maculopathy and their influence on visual acuity (VA), using optical coherence tomography (OCT) and OCT angiography (OCTA).METHODS. This was a retrospective analysis of consecutive patients with radiation maculopathy, 12 months or more after proton-beam irradiation for uveal melanoma, imaged with fluorescein angiography, OCT, and OCTA. Clinical parameters potentially affecting VA were recorded, including OCTA-derived metrics: foveal avascular zone (FAZ) area, vascular density, and local fractal dimension of the superficial (SCP) and deep capillary plexuses (DCP). Nonirradiated fellow eyes served as controls. RESULTS.Ninety-three patients were included. FAZ was larger, while SCP/DCP capillary density and local fractal dimension were lower in the 35 irradiated than in the 35 fellow eyes (P < 0.0001). Microvascular alterations graded on fluorescein angiography (minimally damaged/ disrupted/disorganized) were correlated to FAZ area and SCP/DCP density on OCTA (P < 0.01). By univariate analysis, worse VA was associated to macular detachment at presentation (P ¼ 0.024), total macular irradiation (P ¼ 0.0008), higher central macular thickness (CMT) (P ¼ 0.019), higher absolute CMT variation (P < 0.0001), cystoid edema (P ¼ 0.030), ellipsoid zone disruption (P ¼ 0.002), larger FAZ (P < 0.0001), lower SCP (P ¼ 0.001) and DCP capillary density (P < 0.0001), and lower SCP (P ¼ 0.009) and DCP local fractal dimension (P < 0.0001). Two multivariate models with either capillary density or fractal dimension as covariate showed that younger age (P ¼ 0.014/0.017), ellipsoid zone disruption (P ¼ 0.034/0.019), larger FAZ (P ¼ 0.0006/0.002), and lower DCP density (P ¼ 0.008) or DCP fractal dimension (P ¼ 0.012), respectively, were associated with worse VA.CONCLUSIONS. VA of eyes with radiation maculopathy is influenced by structural and microvascular factors identified with OCTA, including FAZ area and DCP integrity.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 93%

mentioning

confidence: 99%

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Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Matet

Daruich

Zografos

2017

Invest. Ophthalmol. Vis. Sci.

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“…Currently, OCT-A is the most sensitive method with which to detect radiation maculopathy [3,13]. In fact, in a recent study of 65 patients, Shields et al [14] identified parafoveal changes on OCT-A. Here, we report the extent of changes in the superficial capillary plexus, which included the reduction in CVD in all ETDRS sectors.…”

Section: Discussionmentioning

confidence: 82%

Evaluation of Vascular Changes with Optical Coherence Tomography Angiography after Plaque Radiotherapy of Choroidal Melanoma

et al. 2018

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Aim: The purpose of this paper was to evaluate whether optical coherence tomography angiography (OCT-A) can be used to quantify the vascular changes in radiation maculopathy, and changes in the tumor vasculature in eyes treated with plaque radiotherapy for choroidal melanoma. Methods: In this prospective study, we evaluated 39 Caucasian patients with choroidal melanoma (39 eyes) treated with ruthenium-106 plaque radiotherapy. The patients underwent complete ophthalmic examination, bulbar echography, and OCT-A before and 1 year after treatment. Results: At baseline, the mean best-corrected visual acuity (BCVA) in the affected eyes was 0.35 ± 0.40 logMAR, and the mean tumor thickness was 2.68 ± 0.25 mm at A-scan echography. After treatment, the mean BCVA increased to 0.41 logMAR, the mean tumor thickness decreased to 1.66 ± 0.23 mm, and the tumor basal diameter was significantly reduced (U = 108, p = 0.001). Moreover, the capillary vessel density was significantly lower in all Early Treatment of Diabetic Retinopathy Study sectors, and both the vessel and flow areas were significantly reduced (p = 0.030 and p = 0.001, respectively). Conclusions: OCT-A is a noninvasive, reliable method with which to quantify the vessel changes in radiation maculopathy and, given the association between vascularization and malignancy, this procedure may be an aid in treatment decision-making and in monitoring the efficacy of treatment.

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“…The OCT probe insertion-induced edema should be much lower or absent in humans due to availability of dedicated esophageal OCT catheters that can be inserted in a deflated state 32 and because of the larger size of the organ. Previous studies investigated the use of OCT in esophageal and radiation-induced damages, 20,[33][34][35][36][37][38][39][40][41][42][43][44][45][46] the visibility of esophageal layers in OCT images, and the differentiation between healthy and cancerous esophagus. [39][40][41] Esophageal OCT has been used to detect Barrett's esophagus in various studies.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models

et al. 2018

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"Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models," J. Biomed. Opt. 23(4), 046004 (2018), doi: 10.1117/1.JBO.23.4.046004. Abstract. Lung cancer survival is poor, and radiation therapy patients often suffer serious treatment side effects. The esophagus is particularly sensitive leading to acute radiation-induced esophageal damage (ARIED). We investigated the feasibility of optical coherence tomography (OCT) for minimally invasive imaging of the esophagus with high resolution (10 μm) to detect ARIED in mice. Thirty mice underwent cone-beam computed tomography imaging for initial setup assessment and dose planning followed by a single-dose delivery of 4.0, 10.0, 16.0, and 20.0 Gy on 5.0-mm spots, spaced 10.0 mm apart in the esophagus. They were repeatedly imaged using OCT up to three months postirradiation. We compared OCT findings with histopathology obtained three months postirradiation qualitatively and quantitatively using the contrast-to-background-noise ratio (CNR). Histopathology mostly showed inflammatory infiltration and edema at higher doses; OCT findings were in agreement with most of the histopathological reports. We were able to identify the ARIED on OCT as a change in tissue scattering and layer thickness. Our statistical analysis showed significant difference between the CNR values of healthy tissue, edema, and inflammatory infiltration. Overall, the average CNR for inflammatory infiltration and edema damages was 1.6-fold higher and 1.6-fold lower than for the healthy esophageal wall, respectively. Our results showed the potential role of OCT to detect and monitor the ARIED in mice, which may translate to humans. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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Optical Coherence Tomography Angiography of the Macula After Plaque Radiotherapy of Choroidal Melanoma

Cited by 78 publications

References 31 publications

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Radiation Maculopathy After Proton Beam Therapy for Uveal Melanoma: Optical Coherence Tomography Angiography Alterations Influencing Visual Acuity

Evaluation of Vascular Changes with Optical Coherence Tomography Angiography after Plaque Radiotherapy of Choroidal Melanoma

Feasibility of using optical coherence tomography to detect acute radiation-induced esophageal damage in small animal models

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