Enhanced Depth Imaging Optical Coherence Tomography of Choroidal Melanoma Before and After Plaque Radiation Therapy

Abstract

 

Purpose

 

To evaluate characteristics of choroidal melanoma using enhanced depth imaging optical coherence tomography (OCT-EDI) before and after treatment with plaque radiation therapy.

 

Methods

 

A retrospective case series was designed to evaluate OCT-EDI characteristics of choroidal melanoma before and after treatment with plaque radiation therapy. All patients who underwent plaque radiation therapy at the Kellogg Eye Center for choroidal melanoma during a 2-year period between October 1, 2010, and October 1, 2012, and who were imaged with OCT-EDI in the pre-operative and post-operative period were evaluated. Kellogg Eye Center Review Board approval was obtained. Evaluated OCT-EDI features included optical qualities of the melanoma and retinal layer abnormalities. The presence of subretinal fluid, subretinal lipofuscin deposition, and intraretinal edema was noted. The tumor thickness was measured by ultrasonography (millimeters) and OCT-EDI (millimeters) when possible. In OCT-EDI, the tumor thickness was measured in the scan showing greatest tumor thickness by placing the calipers between the base of retina pigment epithelium and the tumor base judged to be at the junction of hyperreflective inner sclera.

 

Results

 

A total of 31 choroidal melanomas underwent OCT-EDI imaging before and after radioactive plaque therapy. Mean age at surgery was 63.1 years (range 33-83 years). Initial post-operative OCT-EDI imaging was obtained at a mean of 141 days (range 79-289 days). Concurrent resolution of subretinal fluid and shaggy photoreceptors was seen in 5 (16.1%) of patients, and resolution of intraretinal edema was seen in 4 (12.9%) of patients, in first post-operative OCT-EDI. Average length of follow-up was 260 days (range 86-597 days). Average time for resolution of subretinal fluid and shaggy photoreceptors was 221 days. Average time for resolution of intraretinal fluid was 176 days.

 

Conclusions

 

Following plaque radiotherapy, OCT-EDI allows a more precise assessment of the intraretinal, subretinal, and choroidal layers. OCT-EDI can be useful in assessing the post-operative response to radioactive plaque therapy of choroidal melanoma.

 

 

OCT-EDI of choroidal melanoma with subretinal fluid and shaggy photoreceptors

 

 

OCT-EDI of same tumor 100 days after plaque radiation therapy, with resolution of subretinal fluid and shaggy photoreceptors

 

Keywords: 589 melanoma • 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 671 radiation therapy