Matet Alexandre, Daruich Alejandra, Zografos Leonidas
Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland.
Invest Ophthalmol Vis Sci. 2017 Aug 1;58(10):3851-3861. doi: 10.1167/iovs.17-22324.
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).
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.
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 = 0.024), total macular irradiation (P = 0.0008), higher central macular thickness (CMT) (P = 0.019), higher absolute CMT variation (P < 0.0001), cystoid edema (P = 0.030), ellipsoid zone disruption (P = 0.002), larger FAZ (P < 0.0001), lower SCP (P = 0.001) and DCP capillary density (P < 0.0001), and lower SCP (P = 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 = 0.014/0.017), ellipsoid zone disruption (P = 0.034/0.019), larger FAZ (P = 0.0006/0.002), and lower DCP density (P = 0.008) or DCP fractal dimension (P = 0.012), respectively, were associated with worse VA.
VA of eyes with radiation maculopathy is influenced by structural and microvascular factors identified with OCTA, including FAZ area and DCP integrity.
使用光学相干断层扫描（OCT）和OCT血管造影（OCTA）分析放射性黄斑病变的微血管和结构变化及其对视力（VA）的影响。
这是一项对连续性放射性黄斑病变患者的回顾性分析，这些患者在接受质子束照射治疗葡萄膜黑色素瘤12个月或更长时间后，接受了荧光素血管造影、OCT和OCTA检查。记录可能影响视力的临床参数，包括OCTA得出的指标：黄斑无血管区（FAZ）面积、血管密度以及浅表毛细血管丛（SCP）和深层毛细血管丛（DCP）的局部分形维数。未受照射的对侧眼作为对照。
纳入93例患者。35例受照射眼的FAZ更大，而SCP/DCP毛细血管密度和局部分形维数低于35例对侧眼（P<0.0001）。荧光素血管造影分级的微血管改变（轻度损伤/中断/紊乱）与OCTA上的FAZ面积和SCP/DCP密度相关（P<0.01）。单因素分析显示，较差的视力与就诊时黄斑脱离（P=0.024）、黄斑全照射（P=0.0008）、较高的中心黄斑厚度（CMT）（P=0.019）、较高的绝对CMT变化（P<0.0001）、囊样水肿（P=0.030）、椭圆体带破坏（P=0.002）、较大的FAZ（P<0.0001）、较低的SCP（P=0.001）和DCP毛细血管密度（P<0.000l）以及较低的SCP（P=0.009）和DCP局部分形维数（P<0.0001）相关。以毛细血管密度或分形维数作为协变量的两个多变量模型显示，年龄较小（P=0.014/0.017）、椭圆体带破坏（P=0.034/0.019）、较大的FAZ（P=0.0006/0.002）以及较低的DCP密度（P=0.008）或DCP分形维数（P=0.012）分别与较差的视力相关。
放射性黄斑病变眼的视力受OCTA识别的结构和微血管因素影响，包括FAZ面积和DCP完整性。
