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Istre-Wilz H, Ebert JJ, Augsburger JJ, Di Nicola M, Correa ZM, Williams BK. Retinal Gliovascular Proliferation Secondary to Retinoblastoma Treated With Radiotherapy. Ophthalmic Surg Lasers Imaging Retina 2024:1-7. [PMID: 39231106 DOI: 10.3928/23258160-20240801-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Retinal gliovascular proliferation (RGVP) is a benign lesion of the retina that can arise idiopathically or secondary to another disease entity. This study describes the clinical features, treatment, and outcomes of six patients with secondary RGVP associated with irradiated, regressed retinoblastoma, and distinguishes it from late local relapse of retinoblastoma. PATIENTS AND METHODS In a retrospective review of available clinical records of 550 patients evaluated for retinoblastoma in a single ocular oncology practice between 1975 and 2022, seven eyes of six patients were identified as having secondary RGVP overlying a treated and regressed retinoblastoma. The clinical features, treatment, and outcomes are described. RESULTS The median age at RGVP diagnosis was 20 years. All RGVPs were associated with a completely regressed retinoblastoma and in proximity to a calcific tumor residue or chorioretinal atrophy that remained after external beam radiotherapy (six eyes) or plaque brachytherapy (one eye). Lesions were measured between 2.8 to 12 mm in largest basal diameter and 1.3 to 4.4 mm in thickness and described as globular, raised areas with focal retinal telangiectasis often associated with overlying subretinal fluid or hemorrhage. Median time between initial retinoblastoma treatment and detection of RGVP was 20 years. Treatment was decided based on evidence of lesion growth and most often consisted of laser photocoagulation and intravitreal anti-VEGF injection. Through available follow-up of the treated lesions, all exhibited at least partial regression, while two untreated lesions remained stable, reassuring us against late local relapse of retinoblastoma. CONCLUSIONS Secondary RGVP develops occasionally in association with regressed previously irradiated retinoblastoma. This lesion must be distinguished from late local relapse of active retinoblastoma. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].
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Shatskikh AV, Yarovoy AA, Gorshkov IM, Gorodetskaya YB. [Morphological features of vasoproliferative tumor of the retina]. Arkh Patol 2024; 86:42-50. [PMID: 38591906 DOI: 10.17116/patol20248602142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Vasoproliferative retinal tumor (VPT) is a term proposed by ophthalmologists in relation to the totality of manifestations of an intraocular volumetric process with involvement of the inner lining of the eye, an integral part of which is the active growth of blood vessels. The available literature data on the morphology of this process are very contradictory and ambiguous. The article presents two clinical cases of vasoproliferative retinal tumor with own illustration of morphological studies.
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Affiliation(s)
- A V Shatskikh
- S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - A A Yarovoy
- S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - I M Gorshkov
- S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
| | - Yu B Gorodetskaya
- S. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russia
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Jong JLZ, Jawaheer L, Spiteri-Cornish K, Chawla A. SURGICAL OUTCOMES OF PARS PLANA VITRECTOMY FOR INTRAOCULAR COMPLICATIONS RELATED TO VASOPROLIFERATIVE TUMOR OF THE RETINA. Retina 2023; 43:1980-1987. [PMID: 37418640 DOI: 10.1097/iae.0000000000003886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
PURPOSE To investigate the safety and efficacy of vitrectomy pars plana vitrectomy in managing intraocular complications relating to vasoproliferative tumors of the retina (VPL). METHODS Retrospective study. 17 patients with VPL who underwent vitrectomy at Sheffield Teaching Hospital NHS Trust from 2005 to 2020 were included. Patient demographics, clinical characteristics, intraoperative data, and surgical outcomes were collected and evaluated. RESULTS The mean age was 52 years. Indications for pars plana vitrectomy included epiretinal membrane (n = 7), vitreous hemorrhage (n = 5), retinal detachment (n = 3), diagnostic (n = 1), and others (n = 1). After pars plana vitrectomy, 14/17 (82.4%) have stabilized vision and 3/17 (17.6%) deteriorated. Subgroup analysis of epiretinal membrane peel had good outcomes with 6/7 (85.7%) noticing improvement or stabilization of symptoms and mean logarithm of minimal angle of resolution visual acuity improved from 0.719 [6/30] ± 0.267 [6/12] to 0.476 [6/19] ± 0.271 [6/12]. Patients undergoing surgery for vitreous hemorrhage also had good outcomes with resolution (and no recurrence) of the hemorrhage in 3/5 (60%) and 5/5 (100%) with one or more surgeries, respectively. Outcomes for retinal detachment surgery were logarithm of minimal angle of resolution 2.126 [HM] ± 0.301 [6/12] preoperatively and 1.185 [6/95] ± 0.522 [6/19] postoperatively, with one recurrence of retinal detachment. In the epiretinal membrane group, three patients had adjunctive treatment for VPL intraoperatively and four patients had none, and no difference found between the two groups in outcome or complications. Tumor with thickness of ≥2 mm exhibited inferior visual outcomes compared with <2 mm ( P < 0.05). CONCLUSION This is one of the largest data sets in looking at outcomes of vitrectomy for complications of VPL. Pars plana vitrectomy is effective and safe in managing VPL-related intraocular complications with good outcomes and a low rate of complications, especially for patients with epiretinal membrane and vitreous hemorrhage.
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Affiliation(s)
- Joel Lee Zher Jong
- Medical School, Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, United Kingdom; and
| | - Lona Jawaheer
- Bristol Eye Hospital, University Hospitals Bristol NHS Trust, Bristol, United Kingdom
| | - Kurt Spiteri-Cornish
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, United Kingdom; and
| | - Anand Chawla
- Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, United Kingdom; and
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Wu M, Ren X, Chen Y, Chen L, Lian H, Li H, Li Q, Zheng B. PATHOLOGIC STUDY OF UNTREATED INTRARETINAL GLIOSIS SURGICALLY EXCISED VIA PARS PLANA VITRECTOMY. Retina 2023; 43:1143-1149. [PMID: 36913626 DOI: 10.1097/iae.0000000000003777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE To evaluate the pathologic process of intraretinal glioses by investigating mass tissues resected from untreated eyes with intraretinal glioses. METHODS Five patients with intraretinal gliosis without previous conservative treatment were included. All patients underwent pars plana vitrectomy. The mass tissues were excised and processed for the pathologic study. RESULTS During surgery, it was observed that the intraretinal gliosis mainly affected the neuroretina and the retinal pigment epithelium was not affected. Pathologic examination revealed that all intraretinal glioses consisted of different proportions of hyaline vessels and hyperplastic spindle-shaped glial cells. In one case, the intraretinal gliosis was mainly composed of hyaline vascular components. In another case, the intraretinal gliosis showed a predominance of glial cells. The intraretinal glioses in the other three cases had vascular and glial components. The proliferated vessels showed different amounts of collagen deposits against different backgrounds. Vascularized epiretinal membrane was found in some intraretinal glioses. CONCLUSION Intraretinal glioses affected the inner retinal layer. Hyaline vessels were the most characteristic pathologic changes; the proportion of proliferative glial cells varied in different intraretinal glioses. The natural course of intraretinal gliosis may involve the proliferation of abnormal vessels in the early stage, which then gradually become scarred and are replaced by glial cells.
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Affiliation(s)
- Mengai Wu
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Xinyu Ren
- Department of Pathology, State Key Laboratory of Complex Severe and Rare Disease, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Lifeng Chen
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Hengli Lian
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Haidong Li
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
| | - Qiuming Li
- Department of Ophthalmology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China; and
| | - Bin Zheng
- Department of Retina Center, Affiliated Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China
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Kiri H, Raval V, Ali H, Das AV, Kaliki S. Vasoproliferative retinal tumors: Clinical presentation and treatment outcome. Eur J Ophthalmol 2022:11206721221149075. [PMID: 36575603 DOI: 10.1177/11206721221149075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To study the clinical presentation and treatment outcomes of patients with vasoproliferative retinal tumor (VPRT) in India. METHODS Retrospective study of 50 eyes in 47 patients. RESULTS Of the 50 eyes, 25 (50%) were primary and 25 (50%) were secondary. Common ocular pathologies related to secondary VPRT included retinal detachment (n = 8, 32%) and Coats disease (n = 7, 28%). Overall, the mean age at presentation was 35 years (range; 3-74 years) and included 30 (64%) males and 17 (36%) females. The lesions were unilateral in 44 (94%) patients. Secondary retinal features included intra/subretinal exudation (n = 41, 82%), vascularity (n = 32, 64%), subretinal fluid (n = 21, 42%), retinal neovascularisation (n = 9, 18%) and vitreous hemorrhage (n = 8, 16%). Thirty-four eyes (68%) underwent cryotherapy, of which 16 eyes (47%) received adjunct intravitreal anti-VEGF (12 eyes) or corticosteroid injection (4 eyes). Primary surgery included vitrectomy with/without encirclage and cryotherapy (n = 12, 24%) and plaque brachytherapy (n = 3, 6%). At last follow-up (mean 9.7 months, range 3-67 months), 42 eyes (84%) had complete tumor regression with no improvement in visual outcomes when comparing presenting and final best corrected visual acuity. Comparing primary versus secondary VPRT, secondary VPRT presented a decade earlier (31 vs 40 years), needed surgical intervention (48% vs 20%), had poor tumor control (72% vs 92%) and worse visual outcomes (p < 0.05). CONCLUSION VPRTs commonly present as a unilateral lesions in the adult population with equal prevalence of primary and secondary variants. Compared with primary VPRT, secondary VPRTs require surgical treatment and are associated with poor visual outcome.
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Affiliation(s)
- Hardik Kiri
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vishal Raval
- Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India.,The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Hasnat Ali
- Center for Biostatistics and Epidemiology, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India.,Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Im S, Park HS, Cho U, La TY. Massive Retinal Gliosis Mistaken as a Malignant Intraocular Tumor in Phthisis Bulbi. Diagnostics (Basel) 2022; 12:diagnostics12123090. [PMID: 36553097 PMCID: PMC9777072 DOI: 10.3390/diagnostics12123090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
Massive retinal gliosis (MRG) is a rare condition of non-neoplastic glial proliferation, which forms massive lesions that fill the eye. MRG is commonly associated with phthisis bulbi (a non-functional eye), congenital anomalies, or malformations. Herein, we report a case of massive retinal gliosis associated with a traumatic phthisis bulbi, which was initially mistaken as a malignant intraocular tumor and confirmed only after an eye enucleation. A 70-year-old woman presented with a protruding ocular mass in her left eye which had slowly grown for a year. She had phthisis bulbi in her left eye due to trauma during her childhood. An orbital CT revealed an intraocular mass lesion with calcifications, raising the possibility of retinoblastoma or other malignant intraocular tumors. Enucleation of the left eye globe was performed. Histopathologic examination revealed exuberant proliferation of the glial cells, metaplastic bone formation, hyalinized vessels, and hyperplasia of the retinal pigment epithelium, confirming the diagnosis of MRG. Although rare, the possibility of MRG should be considered as a differential diagnosis when encountering an intraocular mass lesion, as it can be misdiagnosed as a malignant tumor.
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Affiliation(s)
- Soyoung Im
- Department of Hospital Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
| | - Hong Sik Park
- Department of Hospital Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
| | - Uiju Cho
- Department of Hospital Pathology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
- Correspondence: (U.C.); (T.Y.L.)
| | - Tae Yoon La
- Department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 16247, Republic of Korea
- Correspondence: (U.C.); (T.Y.L.)
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Marquez MA, Fortun J, Iyer P, Harbour JW, Haddock LJ. Pseudoangiomatous retinal gliosis (PARG) treated with iodine plaque in patient with chronic retinal detachment. Am J Ophthalmol Case Rep 2022; 27:101614. [PMID: 35734079 PMCID: PMC9207220 DOI: 10.1016/j.ajoc.2022.101614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To describe a case of a chronic retinal detachment complicated by the development of pre and subretinal hemorrhage secondary to a large pseudoangiomatous retinal gliosis (PARG) that interfered with retinal reattachment. After the lesion was regressed following plaque radiotherapy retinal reattachment was successfully completed. Observations A 56y.o healthy man with known history of a chronic inferior rhegmatogenous retinal detachment (RD) of the left eye (OS) presented to the Bascom Palmer Eye Institute (BPEI) emergency department (ED) complaining of new floaters OS. On examination, the patient had a visual acuity of 20/30 right eye (OD) and 20/200 OS. Fundoscopic examination showed a treated tear in OD and dense vitreous hemorrhage OS. Initial B-scan ultrasonography OS showed an inferior RD with diffuse hyperechoic material in the vitreous cavity, preretinal and subretinal space most consistent with hemorrhage. Three days later the patient presented with further vision loss and a repeat B scan showed total RD and increasing subretinal hemorrhage with a solid mass like lesion. At this point, decision was made to proceed with retinal detachment repair, removal of the vitreous hemorrhage, and retina evaluation. During surgery, a total retinal detachment was encountered with poor view of the inferior retina due to a large round vascular lesion in the subretinal space with surrounding hemorrhage and clots. The retina was reattached during surgery, however, the postop was complicated by recurrence of VH, dense hyphema, increased IOP, recurrence of retinal detachment, and growth of the mass like lesion noted during surgery. Consultation with ocular oncology diagnosed the patient with secondary PARG lesion and plaque radiotherapy was given achieving remarkable regression of the lesion. After the lesion had regressed, successful retinal reattachment was achieved, and the patient had excellent visual recovery. Conclusion and importance PARG lesions are uncommon in particular when associated to chronic retinal detachments. This case highlights the importance of having a high clinical suspicion for the development of these lesions to diagnose them correctly and treat them aggressively with plaque radiotherapy in order to be able to manage the underlying complex retinal detachment.
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Tagami M, Misawa N, Noma-Ishikura S, Honda S, Kase S, Honda S. EPIDERMAL GROWTH FACTOR RECEPTOR EXPRESSION IN A CASE OF FOCAL NODULAR GLIOSIS OF THE RETINA. Retin Cases Brief Rep 2022; 16:375-378. [PMID: 32058355 PMCID: PMC9022684 DOI: 10.1097/icb.0000000000000987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To describe the immunohistochemical profile in a case with focal nodular gliosis (FNG) of the retina. METHODS A 56-year-old female patient presented with vitreoretinal tractional syndrome with FNG of the retina. After resection of the retinal tumor tissue during the 25-G pars plana vitrectomy, immunohistochemistry using anti-epidermal growth factor receptor (EGFR), p-53, Ki67, glial fibrillary acid protein (GFAP), CD34, and vascular endothelial growth factor antibodies was performed in the excised tissue of the FNG of the retina. RESULTS Histopathological analysis of the tumor led to a diagnosis of FNG of the retina. Spindle cells of the tumor exhibited strong positive staining for glial fibrillary acid protein, and there was local staining for CD34 in the endothelial cells in the blood vessels. The epidermal growth factor receptor and vascular endothelial growth factor immunoreactivity were strongly observed in the endothelial cells. CONCLUSION This study demonstrated epidermal growth factor receptor expression in eyes with FNG of the retina. Oncogenic epidermal growth factor receptor might trigger and amplify the expression and function of endothelial vascular endothelial growth factor.
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Affiliation(s)
- Mizuki Tagami
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan; and
| | - Norihiko Misawa
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan; and
| | - Saki Noma-Ishikura
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan; and
| | - Satoshi Honda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan; and
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeru Honda
- Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Osaka City University, Osaka, Japan; and
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Tong L, Jia Y, Wang J, Li Y, Chen Z, Liu S, Zhang L. Case Report: Exacerbation and Spontaneous Separation of the Epiretinal Membrane Following Laser Photocoagulation of a Vasoproliferative Tumor of the Retina. Front Med (Lausanne) 2022; 9:770689. [PMID: 35280881 PMCID: PMC8914037 DOI: 10.3389/fmed.2022.770689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
The present report concerns a rare vasoproliferative tumor of the retina (VPTR) combined with a severe case of secondary epiretinal membrane (ERM). A 56-year-old male patient was diagnosed with VPTR and secondary ERM of the left eye. The patient underwent two rounds of laser photocoagulation (LP) of the tumor. The exacerbation of the ERM was observed after the first round of LP, while spontaneous separation over the five-month follow-up period was noted after the second round of LP. Thus, LP may represent a viable alternative treatment approach for VPTR combined with severe ERM.
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Affiliation(s)
- Luyao Tong
- Department of Ophthalmology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yujie Jia
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Ophthalmology and Otorhinolaryngology, Shaoxing Shangyu Women and Children Hospital, Shaoxing, China
| | - Junliang Wang
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Ningbo Eye Hospital, Ningbo, China
| | - Yan Li
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Zhiqing Chen
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Shelan Liu
| | - Li Zhang
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Li Zhang
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Forgáč F, Sekerešová M, Černák M. EN BLOC RESECTION OF RETINAL VASOPROLIFERATIVE TUMOR USING 23G VITRECTOMY. A CASE REPORT. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2022; 78:206-213. [PMID: 35922148 DOI: 10.31348/2022/22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Retinal vasoproliferative tumor is one of the benign vascular tumors which in advanced stages leads to exudative retinal detachment with the formation of epiretinal and subretinal membranes. In such advanced stages, one of the therapeutic options is pars plana vitrectomy. This article presents the case of a patient on whom was performed 23-gauge pars plana phacovitrectomy with en bloc resection of the tumor followed by histological confirmation. CASE REPORT A 70-year-old patient with a one-year history of unilateral loss of vision in his left eye was admitted to our clinic for examination in February 2018. At admission, the best corrected visual acuity in the right eye was 1.0, and in the left eye was light perception. Based on the clinical picture, sonographic examination of the eye, and fluorescein angiography, the patient was diagnosed with a retinal vasoproliferative tumor. Due to the advanced stage of disease, we proceeded with surgical intervention. We performed 23-gauge phacovitrectomy with a bloc resection of the tumor. Subsequent histological examination confirmed the presence of the presumed tumor. The follow-up exam a few months later showed a completely attached retina with silicone oil tamponade, without exudative retinopathy. However, the best corrected visual acuity improved only slightly to the ability to count fingers at one meter. CONCLUSION Pars plana vitrectomy with en bloc resection of retinal vasoproliferative tumor is one of the therapeutic modalities in advanced stages.
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Diafas A, Toumanidou V, Kassos I, Samouilidou M, Dastiridou A, Ziakas N, Androudi S. Macular sequelae in vasoproliferative tumors: results of surgical approach. Int Ophthalmol 2021; 41:3515-3522. [PMID: 34173151 DOI: 10.1007/s10792-021-01918-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study is to report the clinical manifestations and treatment outcomes in three patients diagnosed with vasoproliferative tumors (VPTs). METHODS A retrospective, single-center case series was conducted, and retinal findings from three cases were documented by clinical examination and multimodal imaging. RESULTS Three patients presented with an elevated, yellow-white retinal lesion located at the peripheral retina and extensive retinal exudation. All three patients were closely monitored, and tumor-associated features included lipid exudates, cystoid macular edema (CMO), pre-retinal fibrosis and epi-retinal membrane (ERM). Clinical management relied on observation, cryotherapy, laser photocoagulation, intravitreal steroids and anti-vascular endothelial growth factor (anti-VEGF) treatment. Despite different clinical courses, two patients underwent vitreo-retinal surgery to address VPT-related complications of macular hole and vitreo-macular traction, whereas a patient underwent phacoemulsification to treat steroid-induced cataract. CONCLUSION VPTs are uncommon benign vascular tumors and usually located at the infero-temporal peripheral retina. Close observation and early diagnosis of VPTs are of great importance in preventing vision-threatening complications and ensuring the best final visual outcome. The optimal treatment has yet to be defined due to lack of multi-center clinical studies. Despite the availability of less invasive therapeutic interventions, however, our case series show that pars plana vitrectomy is sometimes the most appropriate choice to restore visual acuity.
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Affiliation(s)
- Asterios Diafas
- Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | | | - Ioannis Kassos
- Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Maria Samouilidou
- Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Anna Dastiridou
- Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Nikolaos Ziakas
- Department of Ophthalmology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Larissa, Greece.
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Schmelter V, Fuerweger C, Muacevic A, Priglinger SG, Foerster P, Liegl R. Robotic-assisted radiosurgery for the treatment of vasoproliferative tumours. Acta Ophthalmol 2021; 99:456-460. [PMID: 33280249 DOI: 10.1111/aos.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Vasoproliferative tumours (VPT) are a rare but benign entity that can lead to severe visual acuity deterioration. There is no standard of care, and depending on the degree of clinical features, including tumour size and dissemination, visual acuity and subretinal fluid, treatment options include observation, cryotherapy and brachytherapy. Particularly in larger tumours, brachytherapy has advantages over other options, although higher radiation doses and the need for surgical application are disadvantages of this otherwise effective treatment option. CyberKnife radiosurgery might represent an alternative therapeutic option as no surgical intervention is needed and radiation doses are lower. METHODS All patients diagnosed with vasoproliferative tumors who were treated with CyberKnife radiosurgery with a minimum follow-up time of 12 months were included in this case series. We recorded visual acuity, number of lesions, central retinal thickness with optical coherence tomography (OCT) and reflectivity using A-scan standardizes echography every three months. RESULTS A total of four patients with a median age of 34 years (range: 24 - 51) who were observed over an average of 26.5 months (range: 17 - 49 months) matched our inclusion criteria. We appreciated stabilization or increase in visual acuity in all four patients and a regression in tumour thickness with subsequent increase in internal reflectivity as a marker of increasing fibrosis. CONCLUSION We observed good visual and functional outcome following CyberKnife therapy for VPT. We believe that further studies should be pursued to evaluate CyberKnife therapy for the treatment of VPT not treatable with cryo- or lasertherapy.
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Affiliation(s)
- Valerie Schmelter
- Department of Ophthalmology Ludwig‐Maximilians University Munich Germany
| | - Christoph Fuerweger
- European CyberKnife Center Munich Germany
- Center for Neurosurgery Department of Stereotaxy and Functional Neurosurgery University of Cologne Cologne Germany
| | | | | | - Paul Foerster
- Department of Ophthalmology Ludwig‐Maximilians University Munich Germany
| | - Raffael Liegl
- Department of Ophthalmology Ludwig‐Maximilians University Munich Germany
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Bromeo AJ, Lerit SJ, Veloso A, Mercado GJ. Retinal vasoproliferative tumour secondary to retinitis pigmentosa sine pigmento. BMJ Case Rep 2021; 14:14/5/e240878. [PMID: 34011668 DOI: 10.1136/bcr-2020-240878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Retinitis pigmentosa can be associated with exudative vasculopathy in rare instances, which can manifest as retinal vasoproliferative tumours. We present the case of a 33-year-old woman previously diagnosed with retinitis pigmentosa sine pigmentosa in both eyes. She was asymptomatic and just came in for a routine follow-up eye examination. Thorough examination of the peripheral retina on the right eye revealed a dome-shaped retinal tumour with a feeder vessel and surrounding exudative changes at the superotemporal periphery, consistent with a secondary retinal vasoproliferative tumour from retinitis pigmentosa. She subsequently underwent focal laser photocoagulation of the tumour which resulted in tumour stabilisation. While exudative vasculopathy is very uncommon in retinitis pigmentosa, ophthalmologists need to be aware of its occurrence in such patients. Vision loss may occur from exudation, haemorrhage, retinal detachment and neovascularisation. A thorough examination of the peripheral retina is warranted in these cases.
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Affiliation(s)
| | | | | | - Gary John Mercado
- Eye and Vision Institute, The Medical City, Pasig, Philippines.,Department of Ophthalmology and Visual Sciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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de Paula A, Abdolrahimzadeh S, Fragiotta S, Di Pippo M, Scuderi G. Current concepts on ocular vascular abnormalities in the phakomatoses. Semin Ophthalmol 2021; 36:549-560. [PMID: 33755531 DOI: 10.1080/08820538.2021.1900284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neurofibromatosis, Von Hippel Lindau disease, and tuberous sclerosis complex are classified under the term phakomatoses. They are characterized by ocular vascular abnormalities such as vascular tortuosity, corkscrew retinal vessel configuration, moyamoya-like aspect, microaneurysms, hemangioblastomas, and focal sheathing of retinal arteries, possibly due to abnormal formation, migration, and differentiation of neural crest cells. These alterations can be the first sign or the hallmark of disease and can be related to vasoproliferative tumors. PURPOSE Novel imaging technologies in ophthalmology, such as near-infrared reflectances and spectral domain optical coherence tomography, have improved our knowledge in the diagnosis of these pathologies. Previously undetected macular vascular alterations have been reported in phakomatoses using optical coherence tomography angiography. This review will summarize the ophthalmic vascular abnormalities and novel imaging methods in the phakomatoses. CONCLUSION Active research is being led into the ophthalmic management of these conditions and their complications, and owing to elevated vascular endothelial growth factor production from hemangioblastoma, hamartoma, and retinal vascular proliferative tumors, increasing interest in this line of therapy has been conducted although research is still ongoing in this area.
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Affiliation(s)
- Alessandro de Paula
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Solmaz Abdolrahimzadeh
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Serena Fragiotta
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Mariachiara Di Pippo
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Gianluca Scuderi
- NESMOS Department, Ophthalmology Unit, St. Andrea Hospital, University of Rome La Sapienza, Rome, Italy
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Al-Essa RS, Alkatan HM, Arafah MA, Al-Faky YH. Massive Retinal Gliosis in an Infant Microphthalmic Globe: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929363. [PMID: 33497371 PMCID: PMC7849372 DOI: 10.12659/ajcr.929363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 11-month-old Final Diagnosis: Microphthalmos with massive retinal gliosis Symptoms: Microphthalmos with no useful vision, left eye Medication: — Clinical Procedure: Enucleation, left eye Specialty: Ophthalmology • Pathology
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Affiliation(s)
- Rakan S Al-Essa
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hind Manaa Alkatan
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Maria A Arafah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yasser H Al-Faky
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Onishi AC, Jampol LM, Fawzi AA. Optic nerve head reactive retinal astrocytic tumor treated with photodynamic therapy. Am J Ophthalmol Case Rep 2020; 19:100827. [PMID: 32715158 PMCID: PMC7374193 DOI: 10.1016/j.ajoc.2020.100827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 10/25/2022] Open
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Abolfathzadeh N, Naseripour M, Jaberi R, Azma Z, Alemzadeh SA, Arbab M, Sedaghat A. Ru-106 plaque radiotherapy for vasoproliferative tumors of retina: a 15-year single-center experience. Int Ophthalmol 2020; 40:2095-2102. [PMID: 32361860 DOI: 10.1007/s10792-020-01386-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluates the outcomes of ruthenium-106 (Ru-106) plaque brachytherapy for vasoproliferative tumors (VPTs) of the ocular fundus in a single referral ocular oncology center. METHODS The clinical charts of all patients diagnosed with VPT who underwent plaque radiotherapy from 2002 to 2017 were reviewed. Clinical features, types of treatment, outcomes and complications were evaluated. RESULTS Of 46 patients with VPT diagnosis in our ocular oncology clinic, 25 (54.34%) cases were treated with Ru-106 plaque brachytherapy. Eleven patients (44%) were male, and the mean age at the time of diagnosis was 40.92 ± 13.11 years. The mean follow-up time was 47.56 ± 36.87 months. Inferotemporal quadrant was the most common site of the tumor (64.00%). The mean delivered apex and scleral dose was 101.56 ± 6.51 and 412.26 ± 113.66 Gray (Gy), respectively. Initial tumor length, width and thickness were 10.26 ± 3.42, 8.05 ± 2.83 and 4.27 ± 1.10 mm, respectively. The mean tumor thickness decreased to 2.60 ± 0.63 mm, postoperatively. Complete resolution of subretinal fluid around the tumor was achieved in 81.80% of cases. Visual acuity was more than 20/400 in 64% of patients before treatment and 60% of patients at last follow-up. CONCLUSION Our study showed that Ru-106 plaque radiotherapy is an effective and safe method of treatment in VPTs.
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Affiliation(s)
- Navid Abolfathzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.,Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Naseripour
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran
| | - Ramin Jaberi
- Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azma
- Radiation Medicine Department, Shahid Beheshti University, Tehran, Iran
| | - Sayyed Amirpooya Alemzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran
| | - Mona Arbab
- Radiation Oncology Department, Indiana University, Indiana, USA
| | - Ahad Sedaghat
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.
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19
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Comparative Study on the Efficacy and Safety of Tumor Resection in Vitrectomy for Retinal Vasoproliferative Tumors. J Ophthalmol 2019; 2019:7464123. [PMID: 30719338 PMCID: PMC6334322 DOI: 10.1155/2019/7464123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/30/2018] [Accepted: 11/25/2018] [Indexed: 02/08/2023] Open
Abstract
Purpose To investigate the efficacy and safety of combined vitrectomy with tumor resection in the treatment of retinal vasoproliferative tumors (RVPT). Methods Retrospective study. RVPT patients who underwent vitreous surgery at the Eye Hospital of Wenzhou Medical University from January 2011 to July 2017 were included. The main outcomes included treatment type, tumor activity, and best-corrected visual acuity (BCVA). Results Altogether, 16 patients with 17 eyes were enrolled with follow-up of no less than 6 months. Eight eyes were in the resection treatment group (Group R) and 9 eyes were in the conservative treatment group (Group C). Female (69%) were more common. The mean age was 50 (49.72 ± 12.92) years. Fifteen patients got unilateral onset and only one patient suffered bilaterally. The common symptoms were decreased visual acuity, floaters, and visual distortion. The preoperative BCVA ranged from hand movement to 20/20, with an average of 0.82 ± 0.75 LogMAR. Patients were all not high myopia, with a mean axial length of 23.27 ± 0.27 mm (21.61 mm to 24.67 mm). Of the retinal diseases, the epiretinal membrane was the most common, followed by vitreous hemorrhage, uveitis, subretinal fluid, and so on. Compared with the baseline BCVA, it improved more at postoperative 6 months and the last visit in Group R than in Group C (P=0.006 and P=0.033). The BCVA-improved 0.2 LogMAR or above in 6 months was 2 eyes in Group C and 7 eyes in Group R. All tumors in Group R were completely resected, whereas three in Group C (33.3%) had definite activity (P=0.008). In all samples, tumors were located on the inner side of the retina and had small vessel wall thickening and hyaline degeneration. The degree of astrocyte proliferation varies widely among different tumors. Conclusions RVPT was more likely to occur in nonhigh myopia patients. Epiretinal membrane and vitreous hemorrhage were the main causes for vitreous surgery in RVPT patients. Compared with conservative treatment, surgical resection of the tumor is more beneficial to patients on visual acuity recovery and preventing tumor relapse. It is a safe and effective way to treat RVPT.
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Para Prieto M, Saornil MA, de Frutos Baraja JM, García Álvarez C, Diezhandino García P, López Lara F. Episcleral brachytherapy as an effective alternative in vasoproliferative tumors. Int J Ophthalmol 2018; 11:2017-2020. [PMID: 30588439 DOI: 10.18240/ijo.2018.12.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/16/2018] [Indexed: 11/23/2022] Open
Abstract
The aim of this study is to assess the results of episcleral brachytherapy as treatment of retinal vasoproliferative tumors (RVTs) in a referral Intraocular Tumors Unit (ITU). A retrospective review of all patients diagnosed with vasoproliferative tumors of the retina and treated with episcleral brachytherapy in the ITU, University Hospital of Valladolid between 2009 and 2015 was done. Five patients accomplished the inclusion criteria. All of them presented associated exudation and secondary retinal detachments (RD). Four patients had received prior treatments. Decreased tumor size and exudation regression was found in all cases after treatment. Visual acuity remained stable or increased in all patients. No recurrences have been found after twelve-months follow up. The results of the present study suggest that episcleral brachytherapy is an efficient and safe option in the management of vasoproliferative tumors, especially when large tumor or extensive subretinal fluid is present. In these cases episcleral brachytherapy could be considered as a first line treatment.
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Affiliation(s)
- Marta Para Prieto
- Intraocular Tumors Unit, Ophthalmology & Radiotherapy departments, Hospital Clínico Universitario, Valladolid 47005, Spain
| | - Maria Antonia Saornil
- Intraocular Tumors Unit, Ophthalmology & Radiotherapy departments, Hospital Clínico Universitario, Valladolid 47005, Spain
| | - Jesús María de Frutos Baraja
- Intraocular Tumors Unit, Ophthalmology & Radiotherapy departments, Hospital Clínico Universitario, Valladolid 47005, Spain
| | - Ciro García Álvarez
- Intraocular Tumors Unit, Ophthalmology & Radiotherapy departments, Hospital Clínico Universitario, Valladolid 47005, Spain
| | - Patricia Diezhandino García
- Intraocular Tumors Unit, Ophthalmology & Radiotherapy departments, Hospital Clínico Universitario, Valladolid 47005, Spain
| | - Francisco López Lara
- Intraocular Tumors Unit, Ophthalmology & Radiotherapy departments, Hospital Clínico Universitario, Valladolid 47005, Spain
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Walinjkar JA, Sharma US, Rishi P, Rishi E, Gopal L, Sharma T. Clinical features and treatment outcomes of vasoproliferative tumors in Indian participants. Indian J Ophthalmol 2018; 66:246-251. [PMID: 29380768 PMCID: PMC5819105 DOI: 10.4103/ijo.ijo_210_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of the study was to describe the clinical features and treatment outcomes of vasoproliferative tumors (VPT) in Indian participants. Methods: This study design was a retrospective case series in a tertiary eye care center. Case records of patients diagnosed with VPT from 2011 to 2015 were reviewed, and their demographic details, clinical presentation, and treatment outcomes were documented. Baseline and follow-up visual acuity and tumor dimensions were statistically compared by applying paired t-test. Statistical analysis used SPSS version 14. Results: Twenty-two tumors from 19 eyes of 17 patients were included. Mean age at presentation was 43.5 years (range: 15–68 years). Mean presenting best-corrected visual acuity (BCVA) was + 1.10 logMAR. Sixty-eight percent eyes had secondary tumors. Most common association of secondary VPT was Coats disease followed by retinal vasculitis, polypoidal choroidal vasculopathy, familial exudative vitreoretinopathy, and traumatic chorioretinopathy. Ten tumors (45%) involved the inferior quadrant. Tumor-associated features were intra/subretinal exudates, vitritis, subretinal fluid, vitreous hemorrhage, preretinal fibrosis, epiretinal membrane, and subretinal blood. Treatment included cryotherapy, intravitreal or oral steroids, laser photocoagulation, cryotherapy with encirclage, cryotherapy with anti-vascular endothelial growth factor, and observation. Complications included tumor recurrence, retinal detachment, raised intraocular pressure, neovascularization of iris, and cataract. Ninety-five percent VPT regressed at mean 21 months (Median: 17 months; Range: 3–64 months). Mean final BCVA was + 1.21 logMAR. Conclusion: VPTs are commonly unilateral, unifocal, and located anterior to equator in inferior fundus. Secondary tumors are more common than primary tumors. Treatment achieves tumor regression in majority of cases.
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Affiliation(s)
| | | | - Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Ekta Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Lingam Gopal
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Tarun Sharma
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Retinal vasproliferative tumor in a case of X-linked retinoschisis detachment. Am J Ophthalmol Case Rep 2018; 9:48-50. [PMID: 29468219 PMCID: PMC5786862 DOI: 10.1016/j.ajoc.2018.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the first published case of X-linked retinoschisis (XLRS) detachment with retinal vasoproliferative tumor (RVPT) and provide a literature review of the subject. Observations The authors describe a case of a 17 year old male with X-linked retinoschisis who presented with a retinal detachment and a retinal vasoproliferative tumor. The patient was treated with pars plana vitrectomy, endolaser, subtenon's kenalog and anti-VEGF (vascular endothelial growth factor) intravitreal injections. He regained 20/60 vision with a flat macula and had significant resolution of the associated vasoproliferative leakage seen on fluorescein angiography. Conclusions and importance This case adds XLRS to the conditions associated with RVPT and gives support for treatment with laser photocoagulation and anti-VEGF therapy with bevacizumab to control the exudative process.
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Honavar SG. Retinal vasoproliferative tumor - A proposal for classification. Indian J Ophthalmol 2018; 66:185-186. [PMID: 29380753 PMCID: PMC5819090 DOI: 10.4103/ijo.ijo_128_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Santosh G Honavar
- Editor, Indian Journal of Ophthalmology, Editorial Office: Centre for Sight, Road No 2, Banjara Hills, Hyderabad - 500 034, Telangana, India
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Grossniklaus HE, Lenis TL, Jakobiec FA. Retinal Reactive Astrocytic Tumor (Focal Nodular Gliosis): The Entity Also Known as Vasoproliferative Tumor. Ocul Oncol Pathol 2017; 3:161-163. [PMID: 29071266 PMCID: PMC5649332 DOI: 10.1159/000455149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 12/04/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Hans E. Grossniklaus
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tamara L. Lenis
- Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Frederick A. Jakobiec
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, USA
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25
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van Overdam KA, Missotten T, Kilic E, Spielberg LH. Early surgical treatment of retinal hemangioblastomas. Acta Ophthalmol 2017; 95:97-102. [PMID: 27681600 DOI: 10.1111/aos.13223] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 07/10/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the clinical course after early surgical treatment with excision of retinal hemangioblastomas (RHs) before development of major complications. METHODS Interventional case series of four eyes (four patients) with a peripheral RH that had not yet been treated by laser or cryotherapy prior to surgery. All eyes underwent 23-gauge vitrectomy with lesion excision. One patient underwent ligation of the feeder vessel prior to lesion excision. Best-corrected visual acuity and clinical course were assessed during a follow-up period of at least 4 years. RESULTS Four patients (mean age 27.3 years; range 19-32) were included, of whom two had von Hippel-Lindau syndrome. Visual acuity improved in three patients (mean 4.8 lines; range 3-10) and remained stable at 0.0 logMAR in one patient. There were no intraoperative complications. Postoperative complications included transient mild vitreous haemorrhage (n = 2), and local epiretinal membrane formation at the excision location (n = 1). At 4 years postoperatively, there were no long-term complications. There was one case of a new lesion, which was effectively treated with laser. CONCLUSION Vitrectomy with RH excision seems to be an effective approach for larger RHs and could be considered an early treatment option in selected cases. Postoperative complications were limited in scope of this case series. Important points to consider during vitrectomy are effective closure of feeder and draining vessels as well as complete removal of posterior hyaloid and epiretinal membranes in order to avoid postoperative vitreous haemorrhage and proliferative vitreoretinopathy.
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Affiliation(s)
- Koen A. van Overdam
- The Rotterdam Eye Hospital; Rotterdam The Netherlands
- The Rotterdam Ophthalmic Institute; Rotterdam The Netherlands
| | - Tom Missotten
- The Rotterdam Eye Hospital; Rotterdam The Netherlands
| | - Emine Kilic
- Department of Ophthalmology; Erasmus Medical Center; Rotterdam The Netherlands
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PREDICTORS OF TREATMENT RESPONSE OF VASOPROLIFERATIVE RETINAL TUMORS TO RUTHENIUM-106 BRACHYTHERAPY. Retina 2016; 36:2384-2390. [DOI: 10.1097/iae.0000000000001095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hudson LE, Mendoza PR, Yan J, Grossniklaus HE. Reactive Retinal Astrocytic Tumor (Focal Nodular Gliosis): A Case Report. Ocul Oncol Pathol 2016; 3:1-7. [PMID: 28275595 DOI: 10.1159/000448042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/23/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report the clinical and histopathological findings of a reactive retinal astrocytic tumor (RRAT) that progressed to massive retinal gliosis. OBSERVATIONS The patient presented with an elevated, white-yellow retinal mass and extensive retinal exudation in the left eye. Progressive enlargement of the mass and proliferative vitreoretinopathy eventually led to phthisis bulbi and enucleation. Histologically, the mass showed a predominant astrocytic component with intense glial fibrillary acidic protein staining, hyperplasia, fibrous metaplasia, and osseous metaplasia of the retinal pigment epithelium. The Ki-67 proliferative index was <5%, and few scattered vascular channels were observed. CONCLUSIONS AND IMPORTANCE These findings show that this tumor is the result of a reactive glial process rather than of neoplastic vascular proliferation. Massive retinal gliosis probably represents the advanced stage of RRAT.
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Affiliation(s)
- Lauren E Hudson
- Department of Ophthalmology, BT 428 Emory Eye Center, Atlanta, Ga., USA
| | - Pia R Mendoza
- Department of Ophthalmology, BT 428 Emory Eye Center, Atlanta, Ga., USA; L.F. Montgomery Ophthalmic Pathology Laboratory, Department of Ophthalmology, BT 428 Emory Eye Center, Atlanta, Ga., USA; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga., USA
| | - Jiong Yan
- Department of Ophthalmology, BT 428 Emory Eye Center, Atlanta, Ga., USA
| | - Hans E Grossniklaus
- Department of Ophthalmology, BT 428 Emory Eye Center, Atlanta, Ga., USA; L.F. Montgomery Ophthalmic Pathology Laboratory, Department of Ophthalmology, BT 428 Emory Eye Center, Atlanta, Ga., USA; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga., USA
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Wang Q, Day S, Nixon PA, Wong RW. Combined rhegmatogenous and traction detachment associated with vasoproliferative tumor secondary to sickle cell retinopathy. Am J Ophthalmol Case Rep 2016; 4:4-6. [PMID: 29503912 PMCID: PMC5757452 DOI: 10.1016/j.ajoc.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/16/2016] [Accepted: 06/30/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To report the surgical management of a combined rhegmatogenous and traction retinal detachment associated with a vasoproliferative tumor secondary to sickle cell retinopathy. Observations A 29 year old man from Ghana presented with unilateral vision loss, ischemic retina and sea fan neovascularization in both eyes and a retinal detachment nearby a vasoproliferative tumor (VPT) in the left eye. Hemoglobin electrophoresis led to the diagnosis of sickle cell disease. The patient underwent vitrectomy with scleral buckle surgery, resection of the tumor, and removal of subretinal membranes in the left eye. Laser photocoagulation was targeted to areas of ischemic retina in both eyes. Conclusions and Importance: To our knowledge, this is the first report of a combined rhegmatogenous and traction retinal detachment associated with a VPT in sickle cell retinopathy managed by modern vitrectomy techniques. Prompt recognition of the condition and surgical management addressing both rhegmatogenous and tractional components can lead to improved outcome.
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Affiliation(s)
| | - Shelley Day
- Austin Retina Associates, Austin, TX, USA
- Department of Surgery, Texas A&M Health Science Center, Bryan, TX, USA
| | - Peter A. Nixon
- Austin Retina Associates, Austin, TX, USA
- Department of Surgery, Texas A&M Health Science Center, Bryan, TX, USA
| | - Robert W. Wong
- Austin Retina Associates, Austin, TX, USA
- Department of Surgery, Texas A&M Health Science Center, Bryan, TX, USA
- Corresponding author. 801 W. 38th St., Suite 200, Austin, TX 78705, USA.801 W. 38th St.Suite 200AustinTX 78705USA
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Abstract
This article explores the range of tumor specimens that may be submitted to ophthalmic pathology. The handling of complex enucleation and exenteration is described along with smaller eyelid, conjunctival and corneal specimens. The importance of a good understanding of the unique anatomy of the ocular region and detailed clinical information is emphasized as this results in the taking of appropriate blocks for histology and consequently clinically helpful reports. Recommendations for handling specimens where further tissue is required for molecular studies is discussed.
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Affiliation(s)
- Fiona Roberts
- Department of Pathology, Queen Elizabeth University Hospital, Govan Rd, Glasgow G51 4 TF, United Kingdom.
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Nakamura Y, Takeda N, Mochizuki M. A case of vasoproliferative retinal tumor complicated by neovascular glaucoma. Retin Cases Brief Rep 2015; 7:338-42. [PMID: 25383804 DOI: 10.1097/icb.0b013e3182598eea] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of vasoproliferative retinal tumor complicated by neovascular glaucoma that showed remission after vitrectomy surgery to remove the tumor. METHODS A 78-year-old man was referred to the hospital with a complaint of visual loss in his right eye. Corrected visual acuity was 0.5 in the right eye and 1.2 in the left eye. The right eye showed mild vitreous hemorrhage and an elevated lesion in the lower fundus. Fluorescein angiography demonstrated leakage from the tumor, and a 4-mm lesion of high density was seen on computed tomography, and we diagnosed it as retinal capillary hemangioma. In this case, von Hippel-Lindau disease was negative. During the course of the disease, peripheral anterior synechia and neovascularization was seen in the iris and angle, and vitreous surgery was enforced to remove the tumor because of increased intraocular pressure. The tumor was removed as almost one mass. Histologically, the tumor was composed of glial cells and small vessels proliferation. We diagnosed vasoproliferative retinal tumor. RESULTS Seven months after surgery, the intraocular pressure stabilized, and neovascularization of the iris and angle disappeared. Visual acuity was 0.03 due to epiretinal membrane and optic atrophy. There were no signs of recurrence. CONCLUSION The vitreous surgery is one of the effective treatment methods against vasoproliferative retinal tumor complicated by neovascular glaucoma.
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Affiliation(s)
- Yosuke Nakamura
- Departments of *Ophthalmology †Pathology, Hospital, National Center for Global Health and Medicine, Tokyo, Japan
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Cryotherapy-induced release of epiretinal membrane associated with retinal vasoproliferative tumor: analysis of 16 cases. Retina 2014; 34:1644-50. [PMID: 24752009 DOI: 10.1097/iae.0000000000000137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate epiretinal membrane (ERM) response after cryotherapy for retinal vasoproliferative tumors (VPTs). METHOD Retrospective interventional case series. RESULTS Of 16 eyes with VPT and ERM, the tumor was classified as primary in 12 (75%) eyes or secondary in 4 (25%) eyes. The median patient age was 44 years (mean, 43 years; range, 9-70 years). The tumor was located in extramacular zone (n = 16, 100%) and inferotemporal quadrant (n = 12, 75%). The mean tumor base was 6 mm, and thickness was 3 mm. The ERM involved the macula in 12 (75%) eyes and extramacular zone in 4 (25%) eyes, with best-corrected visual acuity of 20/40 or better in 6 (38%) eyes. Associated features included cystoid macular edema (n = 8, 50%), subretinal fluid (n = 10, 63%), vitreous cells (n = 9, 56%), and vitreous hemorrhage (n = 7, 44%). Single-session cryotherapy (double freeze-thaw) to the VPT was performed in each case. Over mean follow-up of 68 months (median, 54 months; range, 8-252 months), tumor regression was documented in 16 (100%) cases, with ERM release in 10 (63%) cases. After ERM release, the foveal anatomy was normal in 12 (75%) eyes. Final visual acuity improved (n = 5, 31%), remained stable (n = 9, 56%), or worsened (n = 2, 13%). Posttreatment best-corrected visual acuity was 20/40 or better in 10 (63%) eyes. CONCLUSION Cryotherapy is remarkably effective for VPT of 6 mm or less in basal dimension. After cryotherapy, VPT-related ERM spontaneously released in 63% of the cases, without the need for surgical intervention.
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Krivosic V, Massin P, Desjardins L, Le Hoang P, Tadayoni R, Gaudric A. Management of idiopathic retinal vasoproliferative tumors by slit-lamp laser or endolaser photocoagulation. Am J Ophthalmol 2014; 158:154-161.e1. [PMID: 24631475 DOI: 10.1016/j.ajo.2014.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE To report the efficacy of laser photocoagulation in treating idiopathic (primary) retinal vasoproliferative tumors. DESIGN Retrospective noncomparative interventional case series. PATIENTS AND METHOD Thirty eyes of 30 patients (22 women and 8 men) with retinal vasoproliferative tumors. Main outcome measures were best-corrected visual acuity (BCVA), presence of retinal hard exudates, retinal detachment (RD), cystoid macular edema (CME), and epiretinal membrane (ERM). Laser photocoagulation was performed at the slit lamp or during pars plana vitrectomy for telangiectasia visible at the retinal vasoproliferative tumors surface. RESULTS Fifteen eyes were treated with slit-lamp laser. Mean follow-up was 36.5 months (range 7 months to 11 years). Mean BCVA increased from 20/40 to 20/32 at the end of the follow-up. Hard exudates and CME regressed completely in 15 of 15 and 5 of 6 eyes, respectively. Fifteen eyes underwent vitrectomy owing to the presence of ERM (10 eyes), large exudative RD (4 eyes), or vitreous hemorrhage (1 eye). Mean follow-up was 24 months (9 months to 3.5 years). Mean BCVA increased from 20/125 to 20/40 at the end of the follow-up. No vision loss occurred. The retina reattached in all cases. Hard exudates regressed completely in 14 of 15 eyes and decreased significantly in 1. Postoperative complications were rhegmatogenous RD in 2 eyes, successfully reattached after additional surgery. CONCLUSION Selective laser photocoagulation of retinal telangiectasia at the retinal vasoproliferative tumors' surface induced the regression of retinal exudation. Slit-lamp laser photocoagulation was sufficient in half of the cases. In more severe conditions, direct endolaser photocoagulation of the telangiectasia was required.
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Affiliation(s)
- Valérie Krivosic
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service d'Ophtalmologie and Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Université Paris Diderot, Paris, France
| | - Pascale Massin
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service d'Ophtalmologie and Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Université Paris Diderot, Paris, France
| | - Laurence Desjardins
- Assistance Publique-Hôpitaux de Paris, Hôpital la Pitié-Salpêtrière, Service d'Ophtalmologie, Université Paris Pierre et Marie Curie, Paris, France
| | - Phuc Le Hoang
- Assistance Publique-Hôpitaux de Paris, Hôpital la Pitié-Salpêtrière, Service d'Ophtalmologie, Université Paris Pierre et Marie Curie, Paris, France; Institut Curie, Service d'Ophtalmologie, Paris, France
| | - Ramin Tadayoni
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service d'Ophtalmologie and Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Université Paris Diderot, Paris, France
| | - Alain Gaudric
- Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Service d'Ophtalmologie and Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'Œil (CERVCO), Université Paris Diderot, Paris, France.
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EXPRESSION OF VASCULAR ENDOTHELIAL GROWTH FACTOR AND INTRAVITREAL ANTI-VEGF THERAPY WITH BEVACIZUMAB IN VASOPROLIFERATIVE RETINAL TUMORS. Retina 2013; 33:1959-67. [DOI: 10.1097/iae.0b013e3182923490] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tocilizumab for retinal vasoproliferative tumor secondary to juvenile idiopathic arthritis-associated uveitis: a case report. Graefes Arch Clin Exp Ophthalmol 2013; 252:163-4. [PMID: 24061910 DOI: 10.1007/s00417-013-2466-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/05/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022] Open
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Reactive retinal astrocytic tumors (so-called vasoproliferative tumors): histopathologic, immunohistochemical, and genetic studies of four cases. Am J Ophthalmol 2013; 155:593-608.e1. [PMID: 23219067 DOI: 10.1016/j.ajo.2012.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the cellular nature of and diagnostic terminology used in connection with acquired retinal "vasoproliferative tumors." DESIGN Retrospective clinicopathologic study. METHODS Clinical records and microscopic slides of 4 enucleated globes were reviewed. Special stains and immunohistochemical probes for CD31, CD34, p53, glial fibrillary acidic protein (GFAP), CD163, and Ki67 (cell replication) were employed; ultrastructural and fluorescence in situ hybridization (FISH) analyses were performed. RESULTS Tumors were located inferotemporally in middle-aged patients. They were uniformly composed of compacted elongated, GFAP-positive spindle cells (due to intermediate filaments identified ultrastructurally) with a Ki67 index of less than 1%. Rosenthal fibers and eosinophilic granular bodies were observed. Hyalinized periodic acid-Schiff-positive vessels were widely separated. CD31 and CD34 revealed a sparse microvasculature. Tumor-associated exudate spread predominantly subretinally. The retinal pigment epithelium had undergone extensive placoid fibrous metaplasia with focal ossification. P53 upregulation, BRAF-KIAA gene rearrangement, and IDH1R132H mutation typically associated with low-grade astrocytic neoplasms were absent. CONCLUSIONS Retinal "vasoproliferative" tumors have been mischaracterized, because they actually display a paucity of microvessels. Proliferating fibrous astrocytes with a very low proliferation index predominate, without immunohistochemical or genetic evidence favoring a neoplasm. Subretinal exudate appeared capable of provoking widespread fibrous metaplasia of the pigment epithelium that was mainly responsible for secondary retinal damage. The term "reactive retinal astrocytic tumor" is proposed as more appropriate for this entity. In carefully selected progressive lesions, consideration should be given to earlier surgical intervention before extensive subretinal exudate accumulates and pigment epithelial proliferation with fibrous metaplasia ensues.
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Noh DH, Sagong M, Chang WH. Three Cases of Vasoproliferative Tumor of the Retina. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.1.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Hyoun Noh
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Sagong
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
| | - Woo Hyok Chang
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea
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Bajorat S, Koinzer S, Bräsen JH, Hugo HH, Roider J. [Histological findings in bilateral asymmetrical vasoproliferative retinal tumor]. Ophthalmologe 2012; 109:1026-9. [PMID: 22810150 DOI: 10.1007/s00347-012-2627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We present a case of a bilateral vasoproliferative tumor of the retina in a young man. The first symptom was visual impairment due to vitreous hemorrhage. The right eye showed small tumors which were successfully treated by repeated cryocoagulation, photocoagulation and bevazicumab injection. The tumor in the left eye was larger and eventually led to a painful secondary glaucoma. After enucleation, this tumor was examined histologically and immunohistochemically. The clinical and histological differential diagnoses and therapeutic options are discussed.
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Affiliation(s)
- S Bajorat
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel.
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Knutsson KA, De Benedetto U, Querques G, Del Turco C, Bandello F, Lattanzio R. Primitive retinal vascular abnormalities: tumors and telangiectasias. ACTA ACUST UNITED AC 2012; 228:67-77. [PMID: 22738997 DOI: 10.1159/000338230] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/09/2012] [Indexed: 11/19/2022]
Abstract
Primitive retinal vascular abnormalities are benign conditions of the retinal circulation that comprise vascular tumors and telangiectasias. The principal vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, racemose hemangiomatosis of the retina and retinal vasoproliferative tumor, while primary retinal telangiectasias include Coats' disease, Leber's miliary aneurysms and idiopathic juxtafoveal telangiectasias. In most cases, these alterations result in significant visual impairment due to exudation determined by the structural abnormalities of the retinal vasculature. The aim of this review is to assess the different clinical and diagnostic features of the single pathological entities and to discuss the available treatment modalities including the onset of intravitreal antivascular endothelial growth factor therapy.
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Affiliation(s)
- Karl Anders Knutsson
- Department of Ophthalmology, San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
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Retinal vasoproliferative tumors in ocular conditions of childhood. J AAPOS 2012; 16:6-9. [PMID: 22370658 DOI: 10.1016/j.jaapos.2011.10.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/01/2011] [Accepted: 10/17/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Retinal vasoproliferative tumor (RVPT) is a vascular mass with exudative retinopathy and minimally dilated feeder vessels. This type of tumor can occur as a primary or secondary condition. Our purpose was to describe secondary vasoproliferative tumors from ocular conditions in childhood. METHODS The clinical records and fundus photographs of patients with secondary RVPTs were reviewed and a detailed literature search was conducted to identify reported cases of secondary RVPTs. This information was used to compile a list of ocular and nonocular childhood conditions associated with development of RVPTs. RESULTS The ocular conditions related to vasoproliferative tumors in children include intermediate uveitis, retinitis pigmentosa, ocular toxocariasis, Coats disease, neurofibromatosis, retinal toxoplasmosis, retinopathy of prematurity, familial exudative vitreoretinopathy, and other rare conditions. CONCLUSIONS Several pediatric ocular conditions can ultimately lead to retinal vasoproliferative tumor.
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Piñeiro-Ces A, Blanco-Teijeiro MJ, Mera-Yáñez MP, Capeans-Tome C. [Ultrasound diagnosis in vasoproliferative tumours of the ocular fundus]. ACTA ACUST UNITED AC 2011; 86:247-53. [PMID: 21821191 DOI: 10.1016/j.oftal.2011.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 03/10/2011] [Accepted: 04/04/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this work is to describe the ultrasound features in vasoproliferative tumours of the ocular fundus (VPTOF). METHODS The medical records corresponding to eight patients were retrospectively studied. Clinical data from the complete ophthalmologic examination and ultrasonographic findings were analysed. RESULTS Nodular masses affecting either the retina or both the retina and the choroid were found. The surface contour of the tumour was regular in 5, and irregular in 3 cases. In terms of dimensions (mm/ SD), the average major base was 7.14/2.56; the minor base 6.74/2.48 and the height 2.38/1.26. Internal structure was always solid and irregular and reflectivity was mostly medium to high in 6 eyes. Angle kappa was not present in any case. No vascularity signs were detected. CONCLUSION According to the results it is suggested that when a differential diagnosis of VPTOF is carried out, not only should ophthalmoscopic signs be studied, but an ultrasound examination should also be done.
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Affiliation(s)
- A Piñeiro-Ces
- Unidad de Retina Quirúrgica y Oncología Ocular, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España.
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Abstract
PURPOSE To describe the clinical appearance and the visual outcome of a cohort of patients with vasoproliferative retinal tumours (VPRTs) that were diagnosed and treated between 2002 and 2007 at the University Hospital of Örebro. METHODS Nine patients with diagnosed VPRTs were included in a retrospective study. The mean age at the time of diagnosis was 50.2 years (range 7-74 years). Follow-up time ranged between 14 and 83 months (mean 42.6). Nine out of ten eyes received cryotherapy; six eyes were also treated with photocoagulation. One patient was treated with intravitreal injections of ranibizumab (Lucentis(®)) and another was referred for brachytherapy. Because of persisting macular oedema, one eye was treated with intravitreal injection of triamcinolon. RESULTS Of the treated eyes, one had anterior uveitis, six had macular oedema at baseline and four had an exudative retinal detachment at the time of diagnosis. Seven eyes underwent vitrectomy because of epiretinal membranes. Visual acuity at diagnosis was 0.21 (mean) (range 0.02-0.6) and at latest check-up 0.30 (mean) (range light perception (LP)-1.0), with improvement in six eyes and deterioration in two. Two out of four patients with retinal detachment were successfully treated surgically. CONCLUSION VPRTs are benign intraretinal changes. Several complications are associated with this condition. All patients in this study had symptom-giving tumours and six patients (six eyes) already had profound macular oedema at presentation. In these cases, when complications have already developed, the final visual prognosis is poor, thereby making it important to detect these tumours early. The patient who received anti-vascular endothelial growth factor (VEGF; Lucentis) therapy showed a slow improvement and distinct regression in exudations during the follow-up time. However, no increase in visual acuity was seen. At latest examination a peripheral exudative retinal detachment was still observed. Whether anti-VEGF treatment is effective, as either an alternative or complementary therapy, must be established in the future.
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Affiliation(s)
- Karim Makdoumi
- Department of Ophthalmology, Örebro University Hospital, Sweden.
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Smith J, Steel D. The Surgical Management of Vasoproliferative Tumours. Ophthalmologica 2011; 226 Suppl 1:42-5. [DOI: 10.1159/000328209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Matsuo T, Tamaki M, Oono T. Retinal vasoproliferative granulomatous lesion associated with hand pyoderma caused by Streptococcus pyogenes. Ocul Immunol Inflamm 2010; 19:58-61. [PMID: 21034303 DOI: 10.3109/09273948.2010.509531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To report a retinal vasoproliferative granulomatous lesion in association with pyoderma. DESIGN Single case report. METHODS A 32-year-old woman had blurred central vision in the right eye, concurrent with pyoderma of the fingers of both hands, 2 days later followed by fever. RESULTS The patient had a granulomatous lesion in the upper retina, which caused leakage, leading to subretinal and intraretinal accumulation of hard exudates in the posterior pole, together with periphlebitis extending over the wider area of the retina. The culture of the pyodermic lesion detected Streptococcus pyogenes. With the 2-month course of amoxicillin-clavulanate, combined with prednisolone tapered from 30 mg daily, the visual acuity (decimal fraction) in the right eye returned from 0.01 (logMAR = 2) to 0.9 (logMAR = 0.1). However, after the discontinuation of the antibiotics and prednisolone, the retinal lesion became more vasoproliferative and caused leakage to reduce the vision again. The leakage was remedied by laser photocoagulation to the retinal lesion. CONCLUSIONS The retinal granulomatous lesion was caused by streptococcal infection in pyoderma and later became more vasoproliferative with macroaneurysms and microaneurysms even after the initial subsidence of the lesion with antibiotics treatment.
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Affiliation(s)
- Toshihiko Matsuo
- Department of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan.
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Abstract
Vasoproliferative tumours are uncommon retinal lesions that may occur in isolation (primary) or in association with another ocular condition (secondary). They may be unilateral or bilateral and have a predilection for the peripheral inferior temporal quadrant of the retina. Vasoproliferative tumours can be associated with abnormalities of the macular, including epiretinal membrane formation and cystoid macular edema. A number of modalities have been used to treat these tumours including cryotherapy and radiotherapy.
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Affiliation(s)
- I G Rennie
- Academic Unit of Ophthalmology and Orthoptics, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.
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Houston SKS, Bourne TD, Lopes MBS, Ghazi NG. Bilateral massive retinal gliosis associated with retinopathy of prematurity. Arch Pathol Lab Med 2009; 133:1242-5. [PMID: 19653718 DOI: 10.5858/133.8.1242] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2009] [Indexed: 11/06/2022]
Abstract
Massive retinal gliosis (MRG) is a rare, benign intraocular condition that may develop in association with long-standing eye conditions including chronic inflammation, vascular disorders, glaucoma, trauma, or congenital abnormalities. It is thought to represent a nonneoplastic reactive tissue response to retinal injury. Here, we describe an unusual case of bilateral MRG in association with retinopathy of prematurity. To our knowledge, this may be the first report of such an occurrence. The differential diagnosis of MRG is discussed with specific emphasis on its relationship to vasoproliferative tumor of the retina and presumed acquired retinal hemangiomas. In addition, we hypothesize that MRG, vasoproliferative tumor of the retina, and presumed acquired retinal hemangiomas may represent different phenotypes along a spectrum of the same disease process.
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Hood CT, Janku L, Lowder CY, Singh AD. Retinal Vasoproliferative Tumor in Association with Neurofibromatosis Type 1. J Pediatr Ophthalmol Strabismus 2009. [PMID: 19645388 DOI: 10.3928/01913913-20090616-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 09/24/2008] [Indexed: 11/20/2022]
Abstract
Retinal vasoproliferative tumor is an uncommon benign vascular tumor that most often occurs sporadically. Vision loss can occur secondary to retinal fibrosis, subretinal exudation, and neovascular glaucoma. This report describes a functionally monocular patient with neurofibromatosis type 1 who had a vasoproliferative tumor with neovascularization of the iris that was successfully treated with intravitreal bevacizumab and cryotherapy.
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Abstract
PURPOSE To describe two patients with peripheral Coats disease-like tumor reaction years after surgical repair for rhegmatogenous retinal detachment. METHODS Retrospective review of two clinical cases. RESULTS Patient 1 presented with visual deterioration caused by a retinal angiomatous tumor and lipid exudates originating from telangiectatic vessels on the scleral buckle 8 years after vitrectomy and encircling band surgery for a giant retinal tear. In Patient 2, a vascularized retinal mass was detected during vitrectomy for a vitreous hemorrhage 24 years after scleral buckling procedures. Both patients were highly myopic and had no history of scleral perforation or angiomatous proliferation before surgery. They underwent vitrectomy and removal of the vascularized tumor. Histologic examination revealed wide lacunae filled with erythrocytes, connective tissue strands with inflammatory cells, and capillaries that showed thickened multilamellar basement membranes. CONCLUSION Secondary Coats disease-like tumor reaction may occur as a late complication years after successful retinal detachment surgery and may be caused by a chronic ischemic and inflammatory stimulus induced by prominent buckling elements in highly myopic eyes.
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Abstract
We present an interventional consecutive case series to describe our experience of transvitreal endoresection (TVE) for vasoproliferative retinal tumours (VPRTs). Three patients with VPRTs refractory to conventional treatment modalities of cryotherapy, plaque radiotherapy and anti-VEGF presented with macular exudative changes and were offered TVE. Complete ophthalmic examination with colour fundal photographs was performed before and during the follow-up period. All patients were followed up for 6 months following silicone oil removal. At the last follow up, resolution of macular and retinal exudative changes with parallel improvement in vision was observed. No recurrences were detected during the follow-up period. Two of three patients had simultaneous cataract surgery and developed fibrinous uveitis, requiring management with intensive topical steroids. After 3 months, these patients had a fibrotic pupillary membrane enveloping the intraocular lens (IOL) with posterior synechiae. These two patients underwent SO removal, IOL explantation and artisan IOL (iris clipped) insertion, resulting in visual improvement. We did not observe any PVR complications in our cases. TVE represents an effective and safe option for the treatment of VPRTs refractory to other treatment modalities. Further studies with a larger sample size and long-term follow up are indicated to evaluate the role of TVE in the management of VPRTs.
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Affiliation(s)
- Syed K Gibran
- Department of Ophthalmology and Visual Sciences, University of Texas Medical Branch, Galveston, TX 77555-1106, USA.
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Bertelli E, Pernter H. Vasoproliferative retinal tumor treated with indocyanine green-mediated photothrombosis. Retin Cases Brief Rep 2009; 3:266-271. [PMID: 25389581 DOI: 10.1097/icb.0b013e3181737700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To assess the efficacy of indocyanine green-mediated photothrombosis (ICGMP) in the treatment of large vascular lesions, and in particular of a 6-mm large, actively exudating vasoproliferative retinal tumor (VPRT). METHODS Thirty minutes after the administration of a loading dose of 1 mg/kg of intravenous ICG multiple, confluent, 2 mm wide, infrared 810 nm diode laser spots were applied on the surface of the tumor. Duration of each spot was 60 seconds, and the power chosen was 400 mW. A subTenon injection of 40 mg triamcinolone suspension was administered immediately after treatment. RESULTS No change in tumor aspect was observed after treatment. ICG late images were taken, showing no perfusion of the lesion. Two weeks after treatment the lesion was remarkably reduced in volume, but residual perfusion on ICG was observed. A second treatment with three laser spots on the diffusion site under the same modalities was performed. After the second treatment a complete obliteration of the lesion could be observed. In the original tumor site patchy retinal pigment epithelium atrophy and hyperplasia appeared. A diffuse, gradual, complete resolution of the exudates is now apparent at the fundus. Vision has slightly improved to 20/100. Follow-up has reached 2 years. CONCLUSION In the presented case ICGMP achieved complete obliteration of a large VPRT. To our knowledge, this is the first VPRT successfully treated with ICGMP, and the largest retinal vascular lesion treated with laser technique reported in the literature. ICGMP is less invasive than cryotherapy and less expensive than recently proposed photodynamic therapy. It may deserve further study in the treatment of selected retinal vascular tumors.
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Affiliation(s)
- Enrico Bertelli
- From Divisione Oculistica, Ospedale Centrale di Bolzano, Comprensorio Sanitario di Bolzano, Azienda Sanitaria Alto Adige-Südtirol, Bolzano, Italy
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