Abstract
Abstract
Introduction
Pediatric optic nerve gliomas are slow-growing tumors that often require treatment if the visual acuity is affected. Recently, optical coherence tomography (OCT) has been utilized to serially measure the retinal nerve fiber layer (RNFL) thickness to assess progression and identify children at highest risk for vision loss. The clinical utility of this testing and whether it will contribute to improved visual outcomes remains to be elucidated.
Methods
We measured 3 patients with optic nerve glioma with optical coherence tomography angiography (OCT-A). OCT-A is a non-invasive test that measures the microvasculature of the retina and choroid by utilizing laser light reflectance of the moving red blood cells. Vascular density (VD) measurement was used to quantify the area occupied by vessels which indicated the nature of the retinal vascular supply and the perfusion of the retinal ganglion cells.
Results
The average age of the three patients was 7.6 years. All gliomas involved the right eye and were treated with Carboplatin and Vincristine along with Bevacizumab. Vascular density measurements with OCT-A revealed an average score of 42.4 (peripapillary) in the affected right eyes and 46.3 (peripapillary) in the normal left eyes. The patient with the lowest visual acuity at presentation (20/100) had the lowest OCT-A measurement (36.8 in the right eye and 56.3 in the left eye). The OCT-A following therapy improved to 39.8 in right eye and the vision improved to 20/25.
Conclusions
Vision recovery has been reported in optic glioma patients treated with Bevacizumab. The radial peripapillary capillary network could be responsible for RNFL nourishment and this may be objectively measured with OCT-A. Future prospective studies are needed to evaluate the utility of OCT-A measurements in pediatric patients with optic nerve glioma as a prognostic predictor for which patients may require treatment and/or potentially benefit from treatment with Bevacizumab.