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Peripapillary vascular changes in radiation optic neuropathy: an optical coherence tomography angiography grading
  1. Raffaele Parrozzani1,
  2. Luisa Frizziero1,
  3. Davide Londei1,
  4. Sara Trainiti1,
  5. Rocco Luigi Modugno1,
  6. Francesca Leonardi1,
  7. Serena Pulze2,
  8. Giacomo Miglionico2,
  9. Elisabetta Pilotto1,
  10. Edoardo Midena1,2
  1. 1 Department of Ophthalmology, University of Padova, Padova, Italy
  2. 2 Ocular Oncology and Toxicology Research Unit, G B Bietti Foundation, IRCCS, Padova, Italy
  1. Correspondence to Professor Edoardo Midena, Department of Ophthalmology, University of Padova, Padova 35128, Italy; edoardo.midena{at}


Aims To investigate peripapillary vascular changes secondary to radiation optic neuropathy (RON) using optical coherence tomography angiography (OCT-A) and to propose a clinical grading of RON based on OCT-A findings.

Methods Thirty-four patients affected by RON were consecutively included. Each patient underwent best corrected visual acuity measurement (ETDRS score) and OCT-A (Nidek RS-3000 Advance device, Nidek, Gamagori, Japan). The radial peripapillary capillary plexus (RPCP) and the entire peripapillary capillary bed (EPCB) were analysed. Quantitative analysis of the OCT-A images was performed using open-source available ImageJ software (National Institutes of Health, Bethesda, Maryland, USA). Qualitative analysis based on the proposed clinical grading (Grades 0–4) was also performed by two masked graders.

Results RON clinical (qualitative) classification based on RPCP correlated with the quantitative RPCP perfusion analysis (P=0.0001). RON clinical classification based on RPCP statistically correlated with ETDRS score (P=0.001). RON clinical classification based on EPCB also correlated with the quantitative EPCB perfusion analysis and ETDRS score (P=0.02 and P=0.01, respectively). Compared with the clinical classification based on EPCB, the qualitative classification based on RPCP reached a higher intergrader agreement (0.96 and 0.86, respectively).

Conclusion OCT-A can be used to detect RPCP abnormalities and to clinically classify RON with a high interexaminer agreement. The proposed clinical classification is supported by the quantitative analysis based on the use of specific images elaboration techniques and correlates with visual acuity of the examined eyes.

  • retina
  • imaging
  • optic nerve
  • neoplasia
  • diagnostic tests/investigation

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  • Contributors RP and EM were responsible for the study conception and design. LF, DL, ST, RLM, FL, SP, GM and EP were responsible for the data acquisition and analysis. All authors equally contributed ot the interpretation, drafting and revising of work, final approval and agreed to be accountable for all aspects of the work.

  • Funding The contribution of the Fondazione Bietti to this paper was supported by the Ministry of Health and Fondazione Roma.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board of University of Padova/Azienda Ospedaliera di Padova.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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