Department of Ophthalmology, University of Padova, Padova, Italy.
Ocular Oncology and Toxicology Research Unit, G B Bietti Foundation, IRCCS, Padova, Italy.
Br J Ophthalmol. 2018 Sep;102(9):1238-1243. doi: 10.1136/bjophthalmol-2017-311389. Epub 2018 Jan 17.
To investigate peripapillary vascular changes secondary to radiation optic neuropathy (RON) using optical coherence tomography angiography (OCT-A) and to propose a clinical grading of RON based on OCT-A findings.
Thirty-four patients affected by RON were consecutively included. Each patient underwent best corrected visual acuity measurement (ETDRS score) and OCT-A (Nidek RS-3000 Advance device, Nidek, Gamagori, Japan). The radial peripapillary capillary plexus (RPCP) and the entire peripapillary capillary bed (EPCB) were analysed. Quantitative analysis of the OCT-A images was performed using open-source available ImageJ software (National Institutes of Health, Bethesda, Maryland, USA). Qualitative analysis based on the proposed clinical grading (Grades 0-4) was also performed by two masked graders.
RON clinical (qualitative) classification based on RPCP correlated with the quantitative RPCP perfusion analysis (P=0.0001). RON clinical classification based on RPCP statistically correlated with ETDRS score (P=0.001). RON clinical classification based on EPCB also correlated with the quantitative EPCB perfusion analysis and ETDRS score (P=0.02 and P=0.01, respectively). Compared with the clinical classification based on EPCB, the qualitative classification based on RPCP reached a higher intergrader agreement (0.96 and 0.86, respectively).
OCT-A can be used to detect RPCP abnormalities and to clinically classify RON with a high interexaminer agreement. The proposed clinical classification is supported by the quantitative analysis based on the use of specific images elaboration techniques and correlates with visual acuity of the examined eyes.
利用光相干断层扫描血管造影术（OCT-A）研究放射性视神经病变（RON）继发的视盘周围血管变化，并根据 OCT-A 结果提出 RON 的临床分级。
连续纳入 34 例 RON 患者。每位患者均接受最佳矫正视力测量（ETDRS 评分）和 OCT-A（尼德克 RS-3000 高级设备，尼德克，滨松，日本）检查。分析放射状视盘周围毛细血管丛（RPCP）和整个视盘周围毛细血管床（EPCB）。使用开源可用的 ImageJ 软件（美国马里兰州贝塞斯达国立卫生研究院）对 OCT-A 图像进行定量分析。两位盲法评估员还根据提出的临床分级（0-4 级）进行定性分析。
基于 RPCP 的 RON 临床（定性）分级与定量 RPCP 灌注分析相关（P=0.0001）。基于 RPCP 的 RON 临床分级与 ETDRS 评分统计学相关（P=0.001）。基于 EPCB 的 RON 临床分级也与定量 EPCB 灌注分析和 ETDRS 评分相关（P=0.02 和 P=0.01）。与基于 EPCB 的临床分级相比，基于 RPCP 的定性分级达到了更高的评估者间一致性（分别为 0.96 和 0.86）。
OCT-A 可用于检测 RPCP 异常，并以较高的评估者间一致性对 RON 进行临床分级。所提出的临床分级得到了基于使用特定图像细化技术的定量分析的支持，与受检眼的视力相关。
