Purpose: To investigate, by means of spectral domain optical coherence tomography (SD-OCT), retinal reflectivity changes as an early biomarker anticipating radiation induced macular edema (ME) in patients treated by Iodine-125 (I-125) brachytherapy. Methods: Thirty patients planned for I-125 brachytherapy because of uveal melanoma (UM) were prospectively included and followed every 4 months for 5 years. Reflectivity alterations, namely hyperreflective retinal foci (HRF) were characterized and counted by two independent masked examiners by means of SD-OCT imaging. HRF were defined as discrete intraretinal reflectivity changes ≤30μm, with reflectivity similar to nerve fiber layer and without back shadowing. Results: ME occurred in seventeen patients 24.2 ±15.1 months (group 1) after irradiation. Thirteen patients showed no signs of ME at 5-year follow-up (group 2). The number of HRF was statistically higher in sequential visits until the evidence of ME in group 1 vs group 2 (p<0.0001). In group 1, HRF at the follow-up before the evidence of ME were significantly related to the OCT central subfield thickness at ME appearance (P=0.0002, r2=0.6129). The intergrader agreement was almost perfect (ICC=0.80). Conclusions: HRF may be considered as an early in vivo imaging biomarker of retinal inflammatory response to ocular irradiation, anticipating the development of radiation maculopathy.
Radiation Maculopathy is Anticipated by OCT Hyperreflective Retinal Foci: a Large, Prospective Confirmation study
Parrozzani, Raffaele;Midena, Giulia;Frizziero, Luisa;Marchione, Giulia;Midena, Edoardo
2021
Abstract
Purpose: To investigate, by means of spectral domain optical coherence tomography (SD-OCT), retinal reflectivity changes as an early biomarker anticipating radiation induced macular edema (ME) in patients treated by Iodine-125 (I-125) brachytherapy. Methods: Thirty patients planned for I-125 brachytherapy because of uveal melanoma (UM) were prospectively included and followed every 4 months for 5 years. Reflectivity alterations, namely hyperreflective retinal foci (HRF) were characterized and counted by two independent masked examiners by means of SD-OCT imaging. HRF were defined as discrete intraretinal reflectivity changes ≤30μm, with reflectivity similar to nerve fiber layer and without back shadowing. Results: ME occurred in seventeen patients 24.2 ±15.1 months (group 1) after irradiation. Thirteen patients showed no signs of ME at 5-year follow-up (group 2). The number of HRF was statistically higher in sequential visits until the evidence of ME in group 1 vs group 2 (p<0.0001). In group 1, HRF at the follow-up before the evidence of ME were significantly related to the OCT central subfield thickness at ME appearance (P=0.0002, r2=0.6129). The intergrader agreement was almost perfect (ICC=0.80). Conclusions: HRF may be considered as an early in vivo imaging biomarker of retinal inflammatory response to ocular irradiation, anticipating the development of radiation maculopathy.
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