Radiation-Induced Optical Coherence Tomography Angiography Retinal Alterations in Patients With Nasopharyngeal Carcinoma

Abstract

Aim: The aim of the study was to investigate the early neurovascular alterations of the retina in radiation encephalopathy (RE) patients with normal-ranged visual acuity after radiotherapy for nasopharyngeal carcinoma.Methods: Fifty-five RE patients and 54 healthy age-matched subjects were enrolled in this retrospective cross-sectional case–control study. The best corrected visual acuity (LogMAR) of the included eye should not be more than 0. The vessel density and thickness of different locations in the retina were acquired automatically using optical coherence tomography angiography (OCTA). The data were then compared between the RE patients and the controls. The location included the whole retina, the superficial vascular plexus (SVP)/the ganglion cell complex (GCC), the deep vascular plexus (DVP), and the choroid in the macular area, as well as the inside disc and peripapillary area in the optic nerve head (ONH). The risk factors in OCTA retinal impairments were analyzed using a backward multiple linear regression. The relationships between mean deviation (MD) and pattern standard deviation (PSD) in the visual field (VF) and the OCTA parameters were also analyzed in RE patients.Results: The vessel density of the GCC was significantly reduced in RE patients compared with controls (p = 0.018), and the reductions were mainly shown in the parafoveal (p = 0.049) and perifoveal fields (p = 0.006). The thickness of the GCC was correspondingly reduced (whole image GCC mean thickness: p = 0.044; parafoveal thickness: p = 0.038; perifoveal thickness: p = 0.038). In addition, the sub-foveal choroidal thickness (p = 0.039) was also reduced in RE patients. The vessel density of the GCC (R2 = 0.643) and DVP (R2 = 0.777) had a significant positive correlation with high-density lipoprotein cholesterol (HDL-C) and apolipoprotein A1 (ApoA1) and had a significant negative correlation with age (GCC: HDL-C, β = 29.89, p = 0.005; ApoA1, β = 78.92, p = 0.002; age, β = −0.886, p = 0.001; DVP: HDL-C, β = 40.09, p = 0.003; ApoA1, β = 62.65, p = 0.013; age, β = −1.31, p = 0.001). The vessel density of the GCC also had a significant negative correlation with apolipoprotein B (ApoB) (β = −32.18, p = 0.006). In the VF, MD had a significant positive correlation with the vessel density inside disc (R2 = 0.241, β = 0.304, p = 0.045), whereas PSD showed a significant negative correlation with the vessel density inside disc and the average GCC thickness, respectively (R2 = 0.437; vessel density inside disc, β = −0.358, p = 0.004; average GCC thickness, β = −0.510, p < 0.001).Conclusion: With the aid of OCTA, we found that neurovascular alterations of the retina may exist in RE patients with normal-ranged visual acuity. Herein, we suggest the implementation of OCTA to assist ophthalmologists in the early detection and consistent monitoring of radiation-related eye diseases to avoid delayed diagnosis.

Radiation optic neuropathy diagnosis in nasopharyngeal carcinoma patients with radiation encephalopathy

“…Most VD and retinal thickness indexes in the macular and ONH areas were significantly reduced in RON compared to NRON, which means that the RON patients included in our study had an overall serious condition, as neural and microvascular impairments emerged throughout the fundus. In a previous study, 7 NRON and healthy controls were compared, and a significant reduction in VD and thickness existed in NRON but was not as distinct as that between RON and NRON in this study. It is possible to be involved in a progressive, irreversible atrophy process after radiation, even for a long time.…”

“…6 RON is more likely to occur in NPC patients with radiation encephalopathy (RE) because the onset of RE may mean a higher dose and a more serious degree in the patients. A previous study 7 showed that the visual field (VF) and retinal vessels were impaired even in RE patients with normal-range visual acuity. Moreover, most RE patients usually refer to the neurology clinic for their initial symptoms, such as headaches, dizziness and dementia.…”