Optical coherence tomography angiography-based analysis of intrinsic vasculature in juxtapapillary melanoma after ruthenium-106 plaque brachytherapy

Abstract

In this case report, we demonstrate the use of optical coherence tomography angiography (OCTA) as a tool to evaluate intrinsic vasculature in a case of juxtapapillary melanoma which underwent ruthinium.106 plaque brachytherapy. In this case, OCTA could demonstrate a decrease in caliber and density of the intrinsic vasculature of the tumor post brachytherapy.

Keywords: Angiography; OCTA; brachytherapy; juxtapapillary; melanoma; response; tumor; vasculature.

Figure 1

(a) Color photograph of right eye showing a brownish, elevated lesion over disc with U-shaped extension below the disc(yellow line). Blood vessels over the lesion can be seen dipping into the tumor. Subretinal fluid was noted around the lesion which involved the fovea (black dotted line). (b) Infrared reflectance image of right eye showing the extent of the lesion. (c) Optical coherence tomography of right eye disc showing a bilobed elevated lesion with high surface reflectivity with back shadowing. Subretinal fluid can be seen adjacent to the lesion

Figure 2

(a) Optical coherence tomography angiography (OCTA) after automatic segmentation. Upper half of the lesion over the disc appears black due to segmentation artifact. (b) OCTA of the same lesion after manual segmentation. (c) OCTA 6 × 6 mm protocol showing large retinal vessel over the tumor with its branches entering the tumor with interlacing of tumor vasculature

Figure 3

Serial color photograph and corresponding 6 × 6 mm OCTA scans at (a) presentation, (b) 3 months after plaque brachytherapy, and (c) 6 months after plaque brachytherapy. Serial photographs show significant decrease in size, color, and caliber of the overlying vessel. Prominent vascular branches seen at presentation could not be noted after brachytherapy indicating decrease in the vascularity of the tumor. Serial OCTA of the lesion demonstrated significant decrease in the caliber and density of the intrinsic vasculature of the tumor

Figure 4

(a) OCTA at 6 months of follow-up with corresponding fluorescein angiography (FA). Note that the vessel seen on OCTA is not seen on FA (white arrow head) and large vessel traversing the tumor is partially obscured by pigment clumps on FA (white arrow). Leakage can be noted around the lesion. (b) OCTA and corresponding indocyanine green angiography (ICG) at 6 months of follow-up. The vascular branches and the intrinsic vasculature were better visualized with OCTA when compared with ICG (white arrow head). Vessel traversing the tumor was segmentally obscured by overlying pigment clumps on ICG (white arrow)