目的:放射性黄斑病变(RM)是质子束治疗(PBT)脉络膜黑色素瘤后视力(VA)丧失的主要原因。这项研究的目的是评估光学相干断层扫描血管造影(OCT-A)对PBT治疗的脉络膜黑色素瘤患者RM的诊断价值。
方法:这个为期2年的前瞻性,描述性,描述性单中心研究纳入了接受PBT治疗的脉络膜黑色素瘤患者.VA测量,视网膜造影,进行OCT和OCT-A。浅表毛细血管丛(SCP)中的血管密度(VD),研究了中央凹周围吻合环的变化和中央凹无血管区(FAZ)的扩大。
结果:本研究纳入了19例患者。中位基线黑色素瘤厚度为5.7[3.6-8.1]mm。中位黑色素瘤至黄斑距离为3.5[2.6-4.6]mm。在视网膜照相术中发现的RM的最早迹象是在12[12-24]个月时发展的硬渗出物,随后是18[12-30]个月的视网膜出血,分别在88.9%和77.8%的患者中发现。在OCT上,最早的体征是在12[6-12]个月时出现/进展的黄斑囊样水肿(CME),发现10例患者(52.6%)。在OCT-A上,100%的患者在12[6-24]个月后出现中央凹吻合环的不连续性和FAZ扩大。12个月后,与基线相比,SCP的VD损失分别为11.7%和10.8%,分别在黄斑和中央凹区域发现。黄斑SCP中VA和VD之间存在显着负相关(R=-0.43;p=0.029)。
结论:OCT-A是PBT治疗脉络膜黑色素瘤患者RM的可靠且有效的诊断工具。
OBJECTIVE: Radiation maculopathy (RM) is the leading cause of visual acuity (VA) loss after proton beam therapy (PBT) of choroidal melanoma. The aim of this
study was to assess the value of optical coherence tomography-angiography (OCT-A) for the diagnosis of RM in patients with choroidal melanoma treated with PBT.
METHODS: This 2-year prospective, descriptive, single-center
study included patients treated with PBT for choroidal melanoma. VA measurement, retinography, OCT and OCT-A were performed. Vascular density (VD) in the superficial capillary plexus (SCP), peri-foveal anastomotic ring changes and foveal avascular zone (FAZ) enlargement were studied.
RESULTS: Nineteen patients were included in the
study. The median baseline melanoma thickness was 5.7 [3.6-8.1] mm. The median melanoma-to-macula distance was 3.5 [2.6-4.6] mm. The earliest signs of RM identified on retinography were hard exudates developing at 12 [12-24] months, followed by retinal hemorrhages at 18 [12-30] months, found in 88.9% and 77.8% of patients respectively. On OCT, the earliest sign was the onset/progression of cystoid macular edema (CME) at 12 [6-12] months, found in 10 patients (52.6%). On OCT-A, 100% of patients presented with a discontinuity of the perifoveal anastomotic ring and a FAZ enlargement after 12 [6-24] months. After 12 months, a VD loss in the SCP by 11.7% and 10.8% compared to baseline, was found in the macular and foveal areas respectively. A significant negative correlation was found between the VA and the VD in the macular SCP (R = -0.43; p = 0.029).
CONCLUSIONS: OCT-A is a reliable and effective diagnostic tool for RM in patients with choroidal melanoma treated with PBT.