脉络膜黑色素瘤斑块放射治疗后黄斑区的光学相干断层扫描血管造影：65例患者中照射眼与未照射眼的比较

OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY OF THE MACULA AFTER PLAQUE RADIOTHERAPY OF CHOROIDAL MELANOMA: Comparison of Irradiated Versus Nonirradiated Eyes in 65 Patients.

作者信息

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

机构信息

Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.

出版信息

Retina. 2016 Aug;36(8):1493-505. doi: 10.1097/IAE.0000000000001021.

DOI:10.1097/IAE.0000000000001021

PMID:26960015

Abstract

PURPOSE

To study radiation retinopathy after plaque radiotherapy of choroidal melanoma using optical coherence tomography angiography.

METHODS

Retrospective comparative analysis of 65 consecutive patients with choroidal melanoma, treated with standard dose I-125 plaque radiotherapy and imaged with optical coherence tomography angiography. A comparison of irradiated versus contralateral, nonirradiated (control) eyes was performed.

RESULTS

The mean patient age was 55 years. Underlying medical diseases included diabetes mellitus (4/65, 4%) or hypertension (25/65, 38%), but no patient demonstrated disease-related retinopathy. The mean pretreatment melanoma diameter was 11 mm and mean thickness was 5 mm. The mean radiation dose to the foveola was 5663 centiGray. At mean follow-up of 46 months after plaque radiotherapy, the most frequent qualitative finding on optical coherence tomography angiography (irradiated eye) was nonperfusion in the superficial capillary plexus (19/65, 29%) and deep capillary plexus (20/65, 31%), followed by loss of choriocapillaris within tumor margins (11/65, 17%). The quantitative findings revealed foveal avascular zone with significantly larger mean area (irradiated vs. nonirradiated eye) in the superficial plexus (0.961 vs. 0.280 mm, P < 0.0001) and deep plexus (1.396 vs. 0.458 mm, P < 0.0001), even in eyes without clinical evidence of radiation maculopathy (superficial 0.278 mm, P = 0.03; deep 0.454 mm, P = 0.02). Parafoveal capillary density (superficial and deep) was decreased in all irradiated eyes (P < 0.001). This difference was maintained after subgroup analysis of eyes with (P < 0.001) or without (P < 0.001) clinical evidence of radiation maculopathy. Mean logMAR visual acuity was significantly reduced in irradiated eyes (0.7 vs. 0.1 [Snellen equivalent 20/100 vs. 20/25], P < 0.001) and the reduced vision was significant even in eyes without clinical evidence of radiation maculopathy (0.4 vs. 0.1 [Snellen equivalent 20/50 vs. 20/25], P < 0.001).

CONCLUSION

Optical coherence tomography angiography demonstrated significant enlargement of the foveal avascular zone and decreased parafoveal capillary density of both superficial and deep capillary plexuses in eyes after plaque radiotherapy of choroidal melanoma, even in eyes with no clinical evidence of radiation maculopathy.

摘要

目的

使用光学相干断层扫描血管造影术研究脉络膜黑色素瘤敷贴放疗后的放射性视网膜病变。

方法

对65例连续的脉络膜黑色素瘤患者进行回顾性对比分析，这些患者接受了标准剂量的碘-125敷贴放疗，并采用光学相干断层扫描血管造影术进行成像。对接受照射的眼睛与对侧未照射（对照）眼睛进行比较。

结果

患者的平均年龄为55岁。基础疾病包括糖尿病（4/65，4%）或高血压（25/65，38%），但没有患者表现出与疾病相关的视网膜病变。黑色素瘤治疗前的平均直径为11毫米，平均厚度为5毫米。黄斑中心凹的平均辐射剂量为5663厘戈瑞。在敷贴放疗后平均随访46个月时，光学相干断层扫描血管造影术（照射眼）最常见的定性结果是浅表毛细血管丛（19/65，29%）和深部毛细血管丛（20/65，31%）无灌注，其次是肿瘤边缘脉络膜毛细血管缺失（11/65，17%）。定量结果显示，浅表丛（0.961对0.280毫米，P<0.0001）和深部丛（1.396对0.458毫米，P<0.0001）中，照射眼的黄斑无血管区平均面积显著更大，即使在没有放射性黄斑病变临床证据的眼睛中也是如此（浅表0.278毫米，P=0.03；深部0.454毫米，P=0.02）。所有照射眼的黄斑旁毛细血管密度（浅表和深部）均降低（P<0.001）。在对有（P<0.001）或无（P<0.001）放射性黄斑病变临床证据的眼睛进行亚组分析后，这种差异仍然存在。照射眼的平均logMAR视力显著降低（0.7对0.1[Snellen视力表等效值20/100对20/25]，P<0.001），即使在没有放射性黄斑病变临床证据的眼睛中，视力下降也很显著（0.4对0.1[Snellen视力表等效值20/50对20/25]，P<0.001）。