Abstract
Purpose :
To describe progressive choroidal vascular changes secondary to ocular irradiation for posterior uveal melanoma (UM).
Methods :
Sixty consecutive eyes of 60 patients affected by primary UM, not directly affecting the posterior pole, and treated with Iodine-125 brachytherapy were enrolled in a prospective study. An age-matched control group was included. Each patient underwent full ophthalmological examination, including best-corrected visual acuity, ophthalmoscopy, ultra-wide field fundus photography, Spectral Domain OCT and OCT Angiography (OCTA). Qualitative and quantitative vascular features of the choriocapillaris were analyzed on OCTA images. The aspect of the large choroidal vessel was also evaluated. Moreover, choroidal vascular index (CVI) -the ratio between the luminal choroidal area (LCA) and the total choroidal area (TCA)- was calculated in the 3000 µm area, centered onto the fovea. Follow-up was performed after 1, 3 and 6 months and every 6 months thereafter. All choroidal vascular changes temporally preceded retinal vascular changes, documented by OCTA.
Results :
Signal void spots were found at the level of choriocapillaris in 54 patients (90%). Rarefaction and dilation of the choroidal vessels were detected in 57 (94%) and 25 (41%) patients, respectively. At the choriocapillaris level, vascular density progressively decreased (p<0.0001). The irradiated eyes exhibited a significantly lower CVI value compared to controls (p<0.0001).
Conclusions :
Radiation side effects are not limited to the retinal vessels but also involve choroidal circulation. These findings strongly suggest that choroidal vasculature changes occur early and precede the retinal ones. Therefore, the role of radiation choroidopathy needs to be adequately recognized and included in the new concept of radiation chorioretinopathy, even in a new therapeutic perspective.
This abstract was presented at the 2023 ARVO Imaging in the Eye Conference, held in New Orleans, LA, April 21-22, 2023.