Fam Anthony, Tomar Ankit S, Finger Paul T
The New York Eye Cancer Center, New York, NY, USA.
Eur J Ophthalmol. 2022 Jul;32(4):2459-2568. doi: 10.1177/11206721211044339. Epub 2021 Sep 16.
To determine a reliable diagnostic method to reveal and monitor subclinical progression of neural and perineural radiation vasculopathy.
A retrospective cross-sectional study, where optical coherence tomography angiography (OCT-A) imaging data was collected and analyzed from 22 consecutive patients that had been treated with circumneural slotted plaque brachytherapy for peripapillary, juxtapapillary, or circumpapillary choroidal melanomas. Pre-operative dosimetry of palladium-103 radiation dose to the optic nerve and fovea were collected. Quantified differences in OCT-A-measured vessel density and length in treated verses untreated contralateral control eyes were collected. Vessel density and length were correlated to radiation dose, plaque slot depth, visual acuity outcomes, and circumpapillary retinal nerve fiber layer thickness.
Patients had post-irradiation follow-up of median 39 months, interquartile range 62 months). The mean optic disc radiation dose was 89.9 Gy ± 39.2 (86.5, 30.8-189.0). In comparison to controls, OCT-A imaging revealed significant differences in radial peripapillary capillary vessel density (18 μm in case eyes, 34 μm in control eyes; < 0.001) and length (10 μm in case eyes, 14 μm in control eyes; < 0.001). Change in vessel density did not show a significant correlation to radiation dose, slot depth, or visual acuity. However, change in vessel length was significantly correlated to radiation dose ( = 0.049) and change in visual acuity ( < 0.001).
OCT-A imaging revealed that radial peripapillary capillary vessel density and length were significantly reduced after circumneural irradiation for choroidal melanoma. Therefore, OCT-A imaging can be used to monitor progression of papillary vasculopathy associated with radiation optic neuropathy.
确定一种可靠的诊断方法，以揭示和监测神经及神经周围放射性血管病变的亚临床进展。
一项回顾性横断面研究，收集并分析了连续22例接受视神经周围开槽斑块近距离放射治疗的视乳头周围、紧邻视乳头或环绕视乳头脉络膜黑色素瘤患者的光学相干断层扫描血管造影（OCT-A）成像数据。收集术前对视神经和黄斑的钯-103辐射剂量的剂量测定数据。收集经治疗的患眼与未治疗的对侧对照眼中OCT-A测量的血管密度和长度的量化差异。血管密度和长度与辐射剂量、斑块开槽深度、视力结果和视乳头周围视网膜神经纤维层厚度相关。
患者放疗后的中位随访时间为39个月，四分位间距为62个月。平均视盘辐射剂量为89.9 Gy±39.2（86.5，30.8 - 189.0）。与对照组相比，OCT-A成像显示视乳头周围放射状毛细血管的血管密度（患眼为18μm，对照眼为34μm；<0.001）和长度（患眼为10μm，对照眼为14μm；<0.001）存在显著差异。血管密度的变化与辐射剂量、开槽深度或视力无显著相关性。然而，血管长度的变化与辐射剂量（=0.049）和视力变化（<0.001）显著相关。
OCT-A成像显示，脉络膜黑色素瘤经神经周围照射后，视乳头周围放射状毛细血管的血管密度和长度显著降低。因此，OCT-A成像可用于监测与放射性视神经病变相关的视乳头血管病变的进展。
