Quantifying Subclinical and Longitudinal Microvascular Changes Following Episcleral Plaque Brachytherapy Using Spectral Domain–Optical Coherence Tomography Angiography

Kyle M. Green, Brian C. Toy, Bright S. Ashimatey, Debarshi Mustafi, Richard L. Jennelle, Melvin A. Astrahan, Zhongdi Chu, Ruikang K. Wang, Jonathan Kim, Jesse L. Berry, Amir H. Kashani

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: This work assesses longitudinal microvascular changes in eyes treated with iodine-125 episcleral plaque brachytherapy (EPB). Methods: High-resolution optical coherence tomography angiograms (OCTAs) of the central 3 × 3-mm macula were obtained from iodine-125 EPB–treated and untreated fellow eyes of 61 patients. Previously validated semiautomated algorithms quantified capillary density (vessel skeleton density [VSD]) and caliber (vessel diameter index). Nonperfusion was also quantified as flow impairment region (FIR). Examinations from treated and fellow eyes obtained before treatment and at 6-month, 1-year, and 2-year intervals were compared using generalized estimating equation linear models. Dosimetry maps evaluated spatial correlation between radiation dose and microvascular metrics. Results: At 6 months, treated eyes had significantly lower VSD (0.145 ± 0.003 vs 0.155 ± 0.002; P =.009) and higher FIR (2.01 ± 0.199 vs 1.46 ± 0.104; P =.01) compared with fellow eyes. There was a significant decrease in VSD and a corresponding increase in FIR even for treated eyes without clinically identifiable retinopathy at 6 months. Vessel diameter index was significantly higher in treated eyes than in fellow eyes at 2 years (2.92 ± 0.025 vs 2.84 ± 0.018; P <.001). We categorized our cohort into low-dose (< 15 Gy) and high-dose (> 45 Gy) radiation to the fovea and noted significant differences in VSD and FIR between groups. Conclusions: OCTA can quantify and monitor EPB-induced retinopathy and can detect vascular abnormalities even without clinically observable retinopathy. OCTA may be useful in investigating treatment interventions aiming to delay EPB-induced radiation retinopathy.

Original languageEnglish (US)
Pages (from-to)499-508
Number of pages10
JournalJournal of VitreoRetinal Diseases
Volume4
Issue number6
DOIs
StatePublished - Nov 1 2020
Externally publishedYes

Keywords

  • biomarker
  • capillary
  • choroidal melanoma
  • episcleral plaque brachytherapy
  • optical coherence tomography angiography
  • radiation retinopathy

ASJC Scopus subject areas

  • Ophthalmology

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