Abstract
BackgroundTo assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomography angiography (OCTA) in treated choroidal melanoma.MethodsIn this retrospective observational case series, we reviewed the recorded data of the patients with unilateral extramacular choroidal melanoma treated with ruthenium − 106 (106Ru) plaque radiotherapy with a follow-up period of more than 6 months. Automatically measured OCTA retinal parameters were analysed after image processing.ResultsThirty-one eyes of 31 patients with the mean age of 51.1 years were recruited. Six eyes had no radiation maculopathy (RM). From 25 eyes with RM, nine eyes (36%) revealed a burnout macular microvasculature with imperceptible vascular details. Twenty-one non-irradiated fellow eyes from the enrolled patients were considered as the control group. Foveal and optic disc radiation dose had the highest value to predict the burnout pattern (ROC, AUC: 0.763, 0.727). Superficial and deep foveal avascular zone (FAZ) were larger in irradiated eyes in comparison to non-irradiated fellow eyes (1629 μm2 vs. 428 μm2, P = 0.005; 1837 μm2 vs 268 μm2, P = 0.021; respectively). Foveal and parafoveal vascular area density (VAD) and vascular skeleton density (VSD) in both superficial and deep capillary plexus (SCP and DCP) were decreased in all irradiated eyes in comparison with non-irradiated fellow eyes (P < 0.001). Compared with non-irradiated fellow eyes, irradiated eyes without RM had significantly lower VAD and VSD at foveal and parafoveal DCP (all P < 0.02). However, these differences at SCP were not statistically significant.ConclusionThe OCTA is a valuable tool for evaluating RM. Initial subclinical microvascular insult after 106Ru brachytherapy is more likely to occur in DCP. The deep FAZ area was identified as a more critical biomarker of BCVA than superficial FAZ in these patients.
Highlights
To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomog‐ raphy angiography (OCTA) in treated choroidal melanoma
In 1300 patients with posterior uveal melanoma treated with Iodine 125 (125I) (Iodide-125) plaque brachytherapy, Gündüz et al reported a rate of 5 and 43% of Radiation retinopathy (RR) based on fundus photography (FP) and fluorescein angiography (FA), at 1 and 5 years, respectively [8]
Using optical coherence tomography (OCT) in 135 uveal melanoma patients treated with 125I brachytherapy, Horgan et al demonstrated that the incidence of macular edema was 17, 40, and 61% at 6 months, and 1 and 2 years thereafter, correspondingly [9]
Summary
To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomog‐ raphy angiography (OCTA) in treated choroidal melanoma. Torkashvand et al BMC Ophthalmol (2021) 21:385 melanoma in the last decades. Both modes cause microvascular injuries in the retina and optic nerve, resulting in macular and optic disc edema, retinal ischemia, retinal hemorrhage, and neovascularization [3, 4]. Using optical coherence tomography (OCT) in 135 uveal melanoma patients treated with 125I brachytherapy, Horgan et al demonstrated that the incidence of macular edema was 17, 40, and 61% at 6 months, and 1 and 2 years thereafter, correspondingly [9]. Another study showed that macular edema can be detected by OCT even 4 months after irradiation which is nearly 5 months earlier than ophthalmoscopic detection [10]
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