Prospective assessment of peripapillary microvasculature using optical coherence tomography angiography in para-optic intracranial and sinonasal tumors treated with proton therapy

Abstract

Purpose: Radiation-induced optic neuropathy (RION) is rare but may lead to blindness. The mechanisms by which this occurs include endothelial and neuronal damage, but RION has been assessed very little in the case of extraocular tumors treated with high-energy proton therapy, the use of which is expanding worldwide. We assessed peripapillary microvascular changes by optical coherence tomography angiography (OCT-A) in patients undergoing high-energy proton therapy for para-optic intracranial or head and neck tumors.Materials and Methods: In this prospective institutional review board approved study, patients receiving > 40Gy_RBE maximal PBT dose to their optic nerve between 2018 and 2020 underwent quantitative OCT-A analyses. ImageJ software was used to assess changes in the peripapillary superficial vascular complex (SVC) using Vascular Area Density (VAD), Vessel Length Density (VLD) and Fractal Dimension (FDsk). Uni- and multivariate analyses were performed.Results: Of 47 patients (78 eyes) with 29 ± 6 months of follow-up (range 18-42), 29 patients (61.7%) had previously undergone surgery, and 18 (32.1%) had microvascular abnormalities prior to proton therapy. Total radiotherapy dose was the most relevant factor in decreased peripapillary microvasculature. Duration of follow-up was associated with lower VAD (p=0.005), and mean retinal nerve fiber layer (RNFLm) thickness also decreased. There was no significant correlation between OCT-A changes and mean visual defect.Conclusion: Peripapillary microvasculature changes may occur from tumor compression or surgery and proton therapy for extraocular tumors. OCT-A may provide quantitative and mechanistic insights into RION before the occurrence of clinical symptoms.