Case Report: Optical coherence tomography angiography findings in radiation retinopathy

Abstract

We reported the observation of a 31-year-old female followed for a nasopharyngeal carcinoma since 2009, treated by locoregional radiotherapy, with a cumulative dose of 75 Gray. The patient presented with a progressive decline in bilateral vision. Ophthalmologic examination revealed bilateral dry eye, posterior subcapsular cataract, radiation retinopathy, and optic neuropathy. The patient presented all ocular complications of radiotherapy. The most severe was radiation retinopathy. Performing optic coherence tomography angiography (OCT-A) earlier could have speeded up the diagnosis and led to a better prognosis. The OCT-A showed more pronounced macular edema in the right eye, and revealed enlargement of the central avascular zone and loss of the deep and superficial retinal vascular network. The patient received three consecutive monthly intravitreal injections of anti-vascular endothelial growth factor. Yet, we noted a non-improved visual acuity. The aim of this case report was to present the contribution of OCT-A in the diagnosis of radiation maculopathy and attribute these changes to ischemia at the level of the retinal vascular network.

Keywords: Deep retinal capillary plexus; Ischemic cascade; OCT angiography; Radiation retinopathy; Superficial retinal capillary plexus.

Figure 1.. Right eye.

a. Fundoscopy showing vascular tortuosity and dilation of peripheral retinal vessels, the disappearance of foveolar reflection, and mild pallor of the optic disc. b. Optical coherence tomography (OCT) showed macular edema. c. OCT angiography (OCT-A) showing enlargement of the centralavascular zone, and hypoperfusion of both superficial and deep retinal capillary network.

Figure 2.. Left eye.

a. Fundoscopy showing vascular tortuosity and dilation of peripheral retinal vessels, the disappearance of foveolar reflection, and mild pallor of the optic disc. b. The optical coherence tomography (OCT) shows macular edema. c. OCT angiography (OCT-A) showing enlargement of the central avascular zone, and hypoperfusion of both superficial and deep retinal capillary network.