Abstract
In this prospective study, we investigated the structural and vascular retinal changes at baseline and after Ranibizumab injections at the last follow up to one year in patients affected by Radiation Maculopathy (RM) after plaque brachytheraphy in choroidal melanoma, using Spectral Domain Optical Coherence Tomography (SD-OCT) and OCT Angiography (OCTA). A total of 40 eyes with RM of 40 patients (18 females, 22 males, mean age 51.9 ± 11 years) that underwent ruthenium-106 plaque brachytherapy were included. All patients received one monthly intravitreal injection of Ranibizumab (Pro Re Nata regimen). We analyzed the Foveal Avascular Zone (FAZ) area, the retinal vessel density (VD) of the superficial capillary plexus (SCP) and of the deep capillary plexus (DCP), using OCTA, and we detected the Central Foveal Thickness (CFT) by SD-OCT at baseline and after treatment. At the last follow up, we found a significant improvement of the CFT (p < 0.001) while OCTA parameters revealed no change in VD of the SCP (p = 0.402), DCP (p = 0.282), and FAZ area (p = 0.255), resulting in a stabilization of the visual acuity (p = 0.210) respect to baseline. The absence of functional improvement, despite the anatomical recovery of the macula, could be due to the absence of improvement in FAZ area and in retinal VD after treatment. OCTA parameters could represent predictive biomarkers to anti-vascular endothelial growth factor (anti-VEGF) intravitreal response and to help to better understand the physiopathological mechanisms of the RM.
Highlights
Radiotherapy is the main treatment for choroidal melanoma and, in particular, ruthenium-106 plaque brachytherapy, it causes a local irradiation, may determine long-term damage to the retinal vascular network with the appearance of radiation maculopathy (RM), which represents a frequent complication [1,2]
The RM is a consequence of compromission of the macular microvasculature that can lead to the leakage, lipid exudates, hemorrhages, teleangiectasie, macular edema, and non perfusion areas with consequent significant impairment of visual acuity [3]
Our results demonstrated in eyes with RM with respect to nonirradiated fellow eyes a significant increase in Central Foveal Thickness (CFT) and Foveal Avascular Zone (FAZ) area, a reduction in retinal vessel density (VD), and an impaired visual acuity, as confirmed by previous reports [4,17,18,19,20,21]
Summary
Radiotherapy is the main treatment for choroidal melanoma and, in particular, ruthenium-106 plaque brachytherapy, it causes a local irradiation, may determine long-term damage to the retinal vascular network with the appearance of radiation maculopathy (RM), which represents a frequent complication [1,2].The RM is a consequence of compromission of the macular microvasculature that can lead to the leakage, lipid exudates, hemorrhages, teleangiectasie, macular edema, and non perfusion areas with consequent significant impairment of visual acuity [3].Previous evidence suggested the role of the anti-vascular endothelial growth factor (VEGF) intravitreal injections in the management of RM in light of the role of vascular permeability in the pathogenesis of macular edema [4,5].The structural changes in the macular region after anti-VEGF treatment have been detected by the Spectral Domain Optical Coherence Tomography (SD-OCT) that it allowed to monitor the radiation-induced macular edema [6].OCTAngiography (OCTA) is the most sensitive imaging method with which to analyze the RM because it provides detailed information on the macular microvasculature and its possible involvement on the visual acuity response after intravitreal treatment [3].The aim of this study was to evaluate the efficacy of anti-VEGF injections on structural and vascular retinal changes in the treatment of RM, using the SD-OCT and OCTA, and the consequent influence on visual acuity. Radiotherapy is the main treatment for choroidal melanoma and, in particular, ruthenium-106 plaque brachytherapy, it causes a local irradiation, may determine long-term damage to the retinal vascular network with the appearance of radiation maculopathy (RM), which represents a frequent complication [1,2]. The structural changes in the macular region after anti-VEGF treatment have been detected by the Spectral Domain Optical Coherence Tomography (SD-OCT) that it allowed to monitor the radiation-induced macular edema [6]. OCTAngiography (OCTA) is the most sensitive imaging method with which to analyze the RM because it provides detailed information on the macular microvasculature and its possible involvement on the visual acuity response after intravitreal treatment [3]. The aim of this study was to evaluate the efficacy of anti-VEGF injections on structural and vascular retinal changes in the treatment of RM, using the SD-OCT and OCTA, and the consequent influence on visual acuity
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