title: Optical Coherence Tomography Angiography Characteristics of Iris Melanocytic Tumors.
abstract: To evaluate tumor vasculature with optical coherence tomography angiography (OCTA) in malignant iris melanomas and benign iris lesions.
  
  
  
  Cross-sectional observational clinical study.
  
  
  
  Patients with iris lesions and healthy volunteers.
  
  
  
  Eyes were imaged using OCTA systems operating at 1050- and 840-nm wavelengths. Three-dimensional OCTA scans were acquired. Iris melanoma patients treated with radiation therapy were imaged again after I-125 plaque brachytherapy at 6 and 18 months.
  
  
  
  OCT and OCTA images, qualitative evaluation of iris and tumor vasculature, and quantitative vessel density.
  
  
  
  One eye each of 8 normal volunteers and 9 patients with iris melanomas or benign iris lesions, including freckles, nevi, and an iris pigment epithelial (IPE) cyst, were imaged. The normal iris has radially oriented vessels within the stroma on OCTA. Penetration of flow signal in normal iris depended on iris color, with best penetration seen in light to moderately pigmented irides. Iris melanomas demonstrated tortuous and disorganized intratumoral vasculature. In 2 eyes with nevi there was no increased vascularity; in another, fine vascular loops were noted near an area of ectropion uveae. Iris freckles and the IPE cyst did not have intrinsic vascularity. The vessel density was significantly higher within iris melanomas (34.5%±9.8%, P < 0.05) than in benign iris nevi (8.0%±1.4%) or normal irides (8.0%±1.2%). Tumor regression after radiation therapy for melanomas was associated with decreased vessel density. OCTA at 1050 nm provided better visualization of tumor vasculature and penetration through thicker tumors than at 840 nm. But in very thick tumors and highly pigmented lesions even 1050-nm OCTA could not visualize their full thickness. Interpretable OCTA images were obtained in 82% of participants in whom imaging was attempted.
  
  
  
  This is the first demonstration of OCTA in iris tumors. OCTA may provide a dye-free, no-injection, cost-effective method for monitoring a variety of tumors, including iris melanocytic lesions, for growth and vascularity. This could be helpful in evaluating tumors for malignant transformation and response to treatment. Penetration of the OCT beam remains a limitation for highly pigmented tumors, as does the inability to image the entire iris in a single field.
authors.affiliation: Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
authors.forename: Alison H
authors.initials: AH
authors.lastname: Skalet
authors.affiliation: Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: Chen D
authors.initials: CD
authors.lastname: Lu
authors.affiliation: Casey Eye Institute, Oregon Health and Science University, Portland, Oregon.
authors.forename: Yali
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: ByungKun
authors.initials: B
authors.lastname: Lee
authors.affiliation: Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts; Pattern Recognition Lab and SAOT, University Erlangen Nuremberg, Erlangen, Germany.
authors.forename: Lennart
authors.initials: L
authors.lastname: Husvogt
authors.affiliation: Pattern Recognition Lab and SAOT, University Erlangen Nuremberg, Erlangen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Maier
authors.affiliation: Electrical Engineering & Computer Science and Research Laboratory of Electronics, Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors.forename: James G
authors.initials: JG
authors.lastname: Fujimoto
authors.affiliation: Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Thomas
authors.affiliation: Casey Eye Institute, Oregon Health and Science University, Portland, Oregon. Electronic address: huangd@ohsu.edu.
authors.forename: David
authors.initials: D
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007498:Iris / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology; D015811:Iris Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D008297:Male; D008544:Melanocytes / Q000473:pathology; D008545:Melanoma / Q000473:pathology* / Q000532:radiotherapy; D008875:Middle Aged; D009508:Nevus, Pigmented / Q000473:pathology; D010865:Pilot Projects; D041623:Tomography, Optical Coherence; D014604:Uveal Neoplasms / Q000473:pathology* / Q000532:radiotherapy; D000098943:Uveal Melanoma