Parafoveal Capillary Density After Plaque Radiotherapy for Choroidal Melanoma

Say, Emil Anthony T.; Samara, Wasim A.; Khoo, Chloe T.L.; Magrath, George N.; Sharma, Priya; Ferenczy, S; Shields, Carol L.

doi:10.1097/iae.0000000000001085

Cited by 39 publications

(47 citation statements)

References 30 publications

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“…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: 94%

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: Discussionmentioning

confidence: 94%

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.…”

Section: Discussionmentioning

confidence: 99%

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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“…Say et al and Cennamo et al quantified total vascular area using 3×3mm and 6×6mm binarized en-face images, respectively. (14, 15) Both demonstrated significant reduction in vessel area density in irradiated eyes compared to fellow eyes. Although the capillary densities in these previous studies were estimated as vessel area density, our preferred method for estimating capillary density is the skeletonized density (VSD).…”

Section: Discussionmentioning

confidence: 90%

“…To date, there have been a few studies that employ OCTA to assess microvascular changes in RR. Two recent studies used binarized OCT angiograms to demonstrate a decrease in parafoveal (14, 15) and peripapillary capillary (16, 17) density in irradiated eyes compared to fellow eyes. To our knowledge, no studies have performed longitudinal analysis to identify early microvascular changes (prior to 1 year) in treated eyes, nor have any used OCTA to explore a possible spatial correlation between these changes and radiation dose.…”

Section: Introductionmentioning

confidence: 99%

Quantifying subclinical and longitudinal microvascular changes following episcleral plaque brachytherapy (EPB) using spectral-domain OCT angiography

Green

Toy

Ashimatey

et al. 2019

Preprint

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4Background: I-125 episcleral plaque brachytherapy (EPB) is standard-of-care for globe-5 conserving treatment of medium-sized choroidal melanomas. Radiation retinopathy is a potential 6 consequence of treatment, characterized by deleterious effects on retinal microvasculature. We 7 investigated the application of Optical Coherence Tomography Angiography (OCTA) for 8 detecting and longitudinally monitoring I-125 episcleral plaque brachytherapy induced radiation 9 retinopathy. 10 11 Methods: High resolution OCTA of the central 3x3mm macula were obtained from I-25 12 episcleral plaque brachytherapy treated and untreated fellow eyes of 62 patients. Capillary 13 density (vessel skeleton density, VSD) and caliber (vessel diameter index, VDI) were quantified 14 using previously validated semi-automated algorithms. Nonperfusion was also quantified as flow 15 impairment regions (FIR). Exams from treated and fellow eyes obtained pre-treatment and at 6-16 month, 1-year, and 2-year intervals were compared using generalized estimating equation linear 17 models. Dosimetry maps were used to evaluate spatial correlation between radiation dose and 18 microvascular metrics. 19 20 Results: Mean time from treatment to last follow-up was 10.8 months. MeanSD and median 21 radiation dose at the fovea were 64.5 ± 76 Gy and 32.0 Gy, respectively. Preoperative logMAR 22

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Parafoveal Capillary Density After Plaque Radiotherapy for Choroidal Melanoma

Cited by 39 publications

References 30 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

Quantifying subclinical and longitudinal microvascular changes following episcleral plaque brachytherapy (EPB) using spectral-domain OCT angiography

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