Optic disc cupping after circumpapillary Pd-103 slotted plaque radiation therapy

Paul T. Finger, Anthony Fam, Ankit S. Tomar, Nathan M. Radcliffe

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: To investigate vascular and morphologic optic disc changes after slotted plaque radiation therapy for choroidal melanoma involving the optic disc. Design: Retrospective cross-sectional study. Participants: Thirty-nine patients with choroidal melanoma involving the optic nerve. Methods: Each melanoma was treated with palladium-103 slotted plaque brachytherapy (incorporating and/or surrounding the optic nerve sheath) between 2005 and 2019. Imaging of the optic nerve before and after radiation allowed for documentation and evaluation of optic nerve pallor and cup-to-disc ratio (CDR) changes. Optical coherence tomography (OCT) CDR measurements and intraocular pressure (IOP) were recorded pretreatment and at follow-up. Of these patients, 22 also had OCT angiography (OCT-A) images with sufficient quality for evaluation of blood vessel density and length. Differences in cup-to-disc measurements were correlated with changes in OCT-A-measured vessel density and length. Results: Following slotted plaque radiation therapy, there was no significant increase in IOP or optic nerve pallor. OCT and colour photography revealed significant increases (both p < 0.001) in CDR from pretreatment to the last follow-up. Increased CDRs on OCT were significantly correlated to OCT-A-measured change in vessel length (p = 0.027). Similarly, increased CDR ratios on fundus photography were significantly correlated with OCT-A-measured change in vessel density (p = 0.043) and length (p = 0.019). Conclusion: Fundus photography and OCT measurements revealed increased optic disc cupping following slotted plaque radiation therapy. Cupping was associated with OCT-A evidence of synchronous progressive peripapillary vascular occlusion and attenuation. Therefore, slotted plaque radiation–induced peripapillary and papillary ischemia was associated with increased CDR ratios and optic disc cupping.

Original languageEnglish
Pages (from-to)262-269
Number of pages8
JournalCanadian Journal of Ophthalmology
Issue number3
StatePublished - Jun 2023
Externally publishedYes


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