Clinical Applications of Optical Coherence Tomography Angiography in Ocular Oncology: Pearls and Pitfalls

Abstract

Background: Optical Coherence Tomography Angiography (OCTA) is a valuable imaging tool for the diagnosis of several retinal and choroidal diseases. Its role in ocular oncology is clinically promising but still controversial. In this review we report the main applications and limits of the use of OCTA for the study of intraocular tumors. Summary: OCTA allows a rapid, safe, low-cost and high-resolution visualization of the retinal and choroidal vasculature. Attempts have been made to use this technology in ocular oncology to differentiate benign and malignant lesions and to assist physicians in the evaluation and monitoring of post-treatment complications. Main limitations include failure in correct segmentation due to tumor inner profile or thickness, poor penetration of laser into the lesion, masking effect from overlying fluid and media opacities and poor fixation. Key messages: The main applications of OCTA in ocular oncology consist in the documentation of tumor-associated choroidal neovascularizations and the study of vascular changes following tumor treatments. In particular, the diffusion of wide-field protocols makes OCTA suitable for the diagnosis and follow-up of radiation chorio-retinopathy allowing a detailed visualoization of both macular and peripheral ischemic changes. Optimistically, future innovations in OCTA technology may offer new perspectives in the diagnosis and follow-up of intraocular tumors.

Radiological Characteristics of Orbital Melanoma

“…In this case, the pertinent MRI findings were mild T1 hyperintensity and moderate enhancement of the bulk of the tumor, with a central nonenhancing region suggestive of necrosis. 2 The low apparent diffusion coefficient signal was suggestive of a highly cellular malignant tumor, consistent with melanoma. 3 A unique feature in our patient was T2 hyperintensity, a sign that can also be seen in orbital lymphoma due to increased cellularity and a high nucleus-to-cytoplasmic ratio.…”

Intralesional Vessel Diameter Measured by Optical Coherence Tomography Angiography Could Improve the Differential Diagnosis of Small Melanocytic Choroidal Lesions

“…Although several previous studies have used OCTA to identify vascular patterns in choroidal melanocytic lesions [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ], the use of this imaging technique remains relatively limited. Moreover, only a few studies have used OCTA to compare choroidal nevi and choroidal melanomas [ 20 , 21 , 22 , 23 ]. In this context, the aim of the present study was to describe and quantify the features of small choroidal melanocytic lesions visualized on OCTA and to identify the vascular factors that may help to identify malignant lesions or those with a high risk of progression.…”

Imaging microvascular changes in nonocular oncological clinical applications by optical coherence tomography angiography: a literature review

“…OCTA has proven highly valuable in helping to better understand and manage a range of nononcological ocular pathologies 11,12,13 , while in oncological ocular clinical applications, OCTA has potential for use in the diagnosis and monitoring of chorioretinal pathologies, such as neovascularization and macular edema. 14 How valuable OCTA could be in quantifying microvascular changes in nonocular clinical oncology remains unclear, and to that end, we decided to systematically review the literature with the intention of exclusively focusing only on studies in which OCTA was performed on patients in the clinical oncology setting.…”