Abstract
Purpose :
Vascular choroidopathy (VC) is a sight-threatening complication of intra-arterial chemotherapy (IAC) for retinoblastoma that remains poorly characterized. In this study, we analyzed retinal and choroidal macular features in eyes affected by VC by means of spectral domain optical coherence tomography (SD-OCT).
Methods :
From 2008 to 2018, 213 eyes underwent a total of 560 IAC in Lausanne. Twenty-one eyes (9.8%) of 21 patients developed VC (<4% of total IAC). For each patient, latest OCT was reviewed. Were excluded eyes with macula not assessable, poor OCT, fellow eye receiving IAC and follow-up <3 months. Fifteen affected eyes were included in the study with fellow eye used as control. Features of ellipsoid zone and retinal pigmented epithelium (RPE), presence/absence of foveola, cystoid macular edema (CME) and additional pathological findings were assessed. Macular thickness (MT) was obtained. Choroidal thickness (CT) was measured at the foveola, at 500μm and 1mm nasally and temporally. Submacular CT was calculated as mean of the five measures. Latest visual acuity (VA) in decimal units was recorded. Statistical analysis was performed using Student's t-test for paired data.
Results :
Mean total number of IAC per eye was 3.1±0.6 (SD) with 2.7±1.0 IAC before first report of VC. Mean age was 5.0±3.2 years. Mean MT in affected eyes was 188.7±62.6μm, compared to 255.1±23.2μm in fellow eyes (P=0.003) with mean difference of -25.0±25.8%. Mean submacular CT was 116.3±76.6μm in affected eyes and 275.5±41.9μm in controls (P<0.0001) with -56.7±29.4% of mean difference. RPE was normal in 1 eye (6.7%), absent in 4 (26.7%), hypertrophic in 6 (40.0%), atrophic in 4 (26.7%). Ellipsoid zone resulted normal in 0 eyes (0%), absent in 8 (53.3%), irregular in 7 (46.7%). Foveola could be identified in 15 eyes (100%), CME in 4 (26.7%). Outer retinal tubulations (ORT) were found in 3 eyes (20%). Mean latest VA was 0.11±0.21.
Conclusions :
The study describes for the first time choroidal and retinal macular changes in patients affected by VC. Retinal and choroidal macular thickness appeared significantly reduced compared to controls. Partial sparing of the foveolar photoreceptors in nearly 50% of the cases holds the promise to keep some vision in eyes with VC provided that OCT-guided aggressive amblyopia therapy is prescribed without delay.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.