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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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Ferreira CC, João D, Furtado A, Sousa-Neves F, Fonseca S, Sepúlveda P, Bilhoto M. Vitrectomy and tumor endoresection for the diagnosis and treatment of focal nodular retinal gliosis. Digit J Ophthalmol 2023; 29:83-87. [PMID: 37780040 PMCID: PMC10539003 DOI: 10.5693/djo.02.2023.07.004] [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: 10/03/2023]
Abstract
We report the case of a 60-year-old woman who presented with metamorphopsia and progressive vision loss in the right eye. Fundus examination revealed an elevated, white-yellow mass in the peripheral inferotemporal retina, with massive retinal exudation, proliferative vitreoretinopathy, and retinal detachment. Pars plana vitrectomy with tumor endoresection was performed, and a complete excisional biopsy of the lesion was obtained by removing the tumor through the anterior chamber. Histopathological analysis of the specimen confirmed a diagnosis of peripheral, focal, nodular retinal gliosis. Postoperatively, visual function improved greatly, with no recurrence of the disease at 12 months' follow-up. Focal nodular retinal gliosis is a rare, non-neoplastic proliferation of retinal glial cells, with a vascular component. In our case, surgical treatment with pars plana vitrectomy facilitated accurate diagnosis and resulted in effective management of the retinal tumor and associated complications.
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Affiliation(s)
- Catarina C. Ferreira
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - David João
- Department of Pathology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Antónia Furtado
- Department of Pathology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Filipe Sousa-Neves
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Sofia Fonseca
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Paula Sepúlveda
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
| | - Miguel Bilhoto
- Department of Ophthalmology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Portugal
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Wójcik-Niklewska B, Sirek S, Tronina A, Filipek E. Isolated retinal astrocytic hamartoma with 7-year follow-up: A case report. Medicine (Baltimore) 2023; 102:e34522. [PMID: 37657027 PMCID: PMC10476716 DOI: 10.1097/md.0000000000034522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/07/2023] [Indexed: 09/03/2023] Open
Abstract
RATIONALE Retinal astrocytic hamartoma (RAH) is a rare benign tumor originating from astrocytic cells located in the neural cell layer of the retina. It is commonly seen in patients with phakomatoses such as tuberous sclerosis complex or neurofibromatosis, rarely as an isolated retinal mass. This lesion is usually asymptomatic; however, these located in the area of the optic nerve, macula, or exhibiting the features of exudation, neovascularization may present visual disturbances and decreased visual acuity. PATIENT CONCERNS We present a rare case of a 15-year-old boy, with no significant past medical history, whose cause of visual disturbances turned out to be isolated RAH. DIAGNOSES Based on the results of color images of the fundus, fluorescein angiography as well as the analysis of magnetic resonance imaging, the patient was diagnosed with RAH. INTERVENTIONS Additionally an B-scan ultrasonography, static and kinetic perimetry were performed. OUTCOMES Fundoscopic examination showed a unilateral yellowish, well-circumscribed, mulberry-like lesion with a wide base, located in inferosnasal quadrant, in the vinicity of the optic nerve. The patient underwent neurological, pediatric, and genetic evaluations that excluded other pathological findings or underlying systemic disease. LESSONS The prognosis for RAH is generally good, however, the lesion requires regular ophthalmologic follow-up to rule out the progression of the tumor mass. The patient 7-year follow-up history is without evidence of tumor growth, local or general deterioration of the condition.
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Affiliation(s)
- Bogumiła Wójcik-Niklewska
- Department of Pediatric Ophtalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Kornel Gibiński University Clinical Centre, Katowice, Poland
| | - Sebastian Sirek
- Department of Pediatric Ophtalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Agnieszka Tronina
- Department of Pediatric Ophtalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Kornel Gibiński University Clinical Centre, Katowice, Poland
| | - Erita Filipek
- Department of Pediatric Ophtalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
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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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Babalola YO, Shah MS, Padhy SK, Behera UC. Bilateral astrocytic hamartoma with vasoproliferative tumour in retinitis pigmentosa. Niger Postgrad Med J 2023; 30:81-84. [PMID: 36814168 DOI: 10.4103/npmj.npmj_265_22] [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: 02/10/2023]
Abstract
We report a rare case of a 32-year-old Indian male who presented to the retina outpatient department with a history of sudden worsening of vision in the left eye. There was a background history of poor vision and deficient night vision since childhood. At the first presentation, the best corrected visual acuity was 6/36 and 6/60 in the right and left eye, respectively. Ocular examination revealed waxy pale disc, bone spicule pigmentation, attenuated vessels and epiretinal membrane in the right eye in keeping with retinitis pigmentosa. An astrocytic harmatoma was also present in the right eye. Vitreous haemorrhage in the left eye precluded a view of the fundus. He subsequently had a left pars plana vitrectomy, and intravitreal bevacizumab on account of non-resolving vitreous haemorrhage and a vasoproliferative tumour and astrocytic hamartoma were noticed intraoperatively. He had a good immediate post-operative outcome post-left vitrectomy but subsequently developed left neovascular glaucoma 2 years after. Neovascular glaucoma may be a sequela of vasoproliferative tumour; hence, regular follow-up and monitoring are essential in these patients.
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Affiliation(s)
- Yewande O Babalola
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India; Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
| | - Miloni S Shah
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India
| | - Srikant K Padhy
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India
| | - Umesh C Behera
- Retina and Vitreous Services, LV Prasad Eye Institute, Mithu Tulsi Chanri Campus, Bhubaneshwar, India
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Boinet R, Bremond-Gignac D, Daruich A. Retinal vasoproliferative tumor as first sign of X-linked retinoschisis in a 12-month-old boy. J AAPOS 2022; 26:343-345. [PMID: 36195134 DOI: 10.1016/j.jaapos.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/10/2022] [Indexed: 11/29/2022]
Abstract
X-linked retinoschisis (XLRS) has been associated with retinal vascular abnormalities, but retinal vasoproliferative tumor (RVPT) has been rarely reported in this context. We describe the case of a 12-month-old boy presenting with esotropia of his left eye due to extensive exudation secondary to RVPT. Right eye examination revealed macular and bullous peripheral retinoschisis. Combining laser photocoagulation and intravitreal injections of anti-vascular endothelial growth factor allowed control of the exudative process at 12 months follow-up. RVPT could be the first sign of XLRS.
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Affiliation(s)
- Romane Boinet
- Ophthalmology Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France; INSERM, UMRS1138, Team 17, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France
| | - Alejandra Daruich
- Ophthalmology Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, Paris, France; INSERM, UMRS1138, Team 17, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, Paris, France.
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SURGICAL OUTCOMES OF VASOPROLIFERATIVE RETINAL TUMORS' REFRACTORY TO NONINVASIVE THERAPIES. Retina 2022; 42:1772-1779. [PMID: 35994586 DOI: 10.1097/iae.0000000000003520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the outcomes of surgical treatment of refractory vasoproliferative retinal tumors (VPTs) and its complications. METHODS Clinical charts of all patients diagnosed with VPTs who underwent surgical treatment from 2005 to 2020 were reviewed. Clinical features, surgical techniques, and outcomes were evaluated. RESULTS From 25 eyes of 23 patients with VPTs, 17 (68%) eyes underwent surgical intervention to treat tumor activity and associated complications including epiretinal membrane (n = 10, 59%), retinal detachment (n = 8, 47%), and vitreous hemorrhage (n = 3, 18%). All eyes underwent pars plana vitrectomy with endolaser/cryotherapy to control tumor activity and to treat associated complications. Three cases required tumor resection. At the end of follow-up (mean 55.4 months, range 2-305 months), no eye presented tumor activity or retinal detachment after one or two surgeries. There was no epiretinal membrane recurrence. The mean baseline best-corrected visual acuity was 1.2 ± 0.7 logMAR, and the mean final best-corrected visual acuity was 0.7 ± 0.6 logMAR ( P < 0.05). The best-corrected visual acuity improved two or more lines in 12 (70.5%) eyes at the end of follow-up. CONCLUSION In this series of patients with large active VPTs, surgical intervention allowed control of the tumor activity in all patients and provided overall satisfactory anatomic and functional outcomes.
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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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Case MJ, Lentz C, Duffy EW, Magrath GN, Cooper SL. Large Vasoproliferative Retinal Tumor Refractory to Cryotherapy Treated with Salvage I-125 Plaque Radiotherapy. Adv Radiat Oncol 2022; 7:100972. [PMID: 35665307 PMCID: PMC9160674 DOI: 10.1016/j.adro.2022.100972] [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: 12/21/2021] [Accepted: 04/12/2022] [Indexed: 10/28/2022] Open
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İpek ŞC, Tunç M, Oysul K, Yaman A, Saatci AO. CyberKnife Stereotactic Radiotherapy in Secondary Vasoproliferative Tumor of the Retina. Case Rep Ophthalmol 2021; 12:264-269. [PMID: 34054468 PMCID: PMC8138144 DOI: 10.1159/000513109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
A 16-year-old boy with X-linked retinoschisis was examined for the visual decline on his left eye. Upon examination, a vasopermeable elevated mass lesion was determined at the lower temporal retinal periphery associated with surrounding arc-like hard exudates which is consistent with a vasoactive proliferative tumor of the retina. After discussing the therapeutic options with the patient and his parents, 3 successive dexamethasone implants 6 months apart were administered. As no satisfactory regression was noticed, CyberKnife stereotactic radiosurgery (SRS) was performed. Regression of the exudative tumor was obtained in follow-up examinations at 12 and 24 months after the SRS session and the thickness of the lesion was markedly reduced.
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Affiliation(s)
- Şefik Can İpek
- Department of Ophthalmology, Ağrı Research and Training Hospital, Ağrı, Turkey
| | - Murat Tunç
- Department of Ophthalmology, Tunç Eye Clinic, Ankara, Turkey
| | - Kaan Oysul
- Department of Radiation Oncology, Medicana Hospital, Ankara, Turkey
| | - Aylin Yaman
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
| | - Ali Osman Saatci
- Department of Ophthalmology, Dokuz Eylul University, Izmir, Turkey
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Management of Vasoproliferative Tumors of the Retina with Macular Complications by Pars Plana Vitrectomy Combined with Episcleral Cryotherapy. J Ophthalmol 2021; 2021:6667755. [PMID: 33953967 PMCID: PMC8057872 DOI: 10.1155/2021/6667755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the efficacy of pars plana vitrectomy (PPV) combined with episcleral cryotherapy in treating vasoproliferative tumors of the retina (VPTR) with macular complications. Methods In this retrospective noncomparative interventional case-series analysis, we included 11 eyes of ten patients diagnosed with VPTR. All patients underwent comprehensive ophthalmic examinations and were treated with PPV combined with episcleral cryotherapy. Best-corrected visual acuity (BCVA), tumor activity, retinal morphological structure, and postoperative complications were evaluated. Results Macular complications included epimacular membrane (n = 10), macular hole (n = 3), and macular edema (n = 1). Tumors were treated with triple freeze-thaw episcleral cryotherapy during PPV. The mean logarithm of minimal angle of resolution (logMAR) BCVA dropped from 0.62 ± 0.58 to 0.39 ± 0.46. The difference between the mean values of logMAR BCVA before and after treatment was statistically significant (t = 2.48, P=0.033). The tumor activity was controlled effectively in nine cases. Compared with preoperative tumor activity, tumor activity after treatment was significantly lower (P < 0.01). The increase of central retinal thickness and the disruption of retinal layers were associated with macular holes, macular edema, and retinal proliferative membrane. After the treatment, visual acuity improved in 91% of the cases, and 73% had no long-term complications. Conclusion PPV combined with episcleral cryotherapy promoted tumor regression, preserved retinal integrity, and improved visual acuity. Thus, the combination of PPV with episcleral cryotherapy can be considered effective and safe for the management of VPTR with macular complications.
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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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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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Uner OE, Rao P, Hubbard GB. Reactivation of Retinopathy of Prematurity in Adults and Adolescents. Ophthalmol Retina 2020; 4:720-727. [PMID: 32224099 DOI: 10.1016/j.oret.2020.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To review the clinical features, treatment outcomes, and prevalence within our clinic population of adolescents and adults with previously regressed retinopathy of prematurity (ROP) who demonstrate late-onset exudation and vasoproliferative changes. DESIGN Retrospective review of consecutive patients at a single center. PARTICIPANTS Five patients (5 eyes) with a history of ROP who showed new exudates or worsening fibrovascular proliferation diagnosed after 10 years of age. METHODS Patients were identified by a computerized search of the Emory Eye Center billing records. Data extracted from charts included baseline ROP information, visual acuity and other examination findings, imaging, and treatments. MAIN OUTCOME MEASURES Status of exudation and vasoproliferation. RESULTS Among 138 patients older than 10 years with ROP seen at our tertiary referral center from 2000 through 2018, 5 (3.6%) demonstrated late-onset exudation or vasoproliferation. Three patients were female and 3 underwent ROP treatment as neonates. Mean age at onset of late reactivation was 25.6 years (range, 13-43 years). Previous treatments for neonatal ROP included peripheral laser ablation (n = 3), scleral buckle (n = 2), pars plicata vitrectomy (n = 2), and no treatment (n = 2). Management strategies for late reactivation included observation (n = 1), intravitreal anti-vascular endothelial growth factor agents (n = 4), vitrectomy (n = 2), and cryotherapy (n = 1). With mean follow-up of 4.8 years (range, 1-7 years), outcomes were resolution of exudation or proliferation with return to baseline vision (n = 2), stable mild exudation (n = 1), and progressive vasoproliferation with traction leading to phthisis (n = 2). CONCLUSIONS Late-onset exudation and fibrovascular proliferation in adolescents and adults with ROP can occur rarely with previously regressed ROP. Two of 5 patients were refractory to all treatments and demonstrated phthisis bulbi. One patient showed reactivation in the form of a reactive retinal astrocytic tumor. Our findings highlight the importance continued monitoring with regular fundus examination in adolescents and adults with regressed ROP.
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Affiliation(s)
- Ogul E Uner
- Emory University School of Medicine, Atlanta, Georgia
| | - Prethy Rao
- Emory University School of Medicine, Atlanta, Georgia; The Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - G Baker Hubbard
- Emory University School of Medicine, Atlanta, Georgia; The Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia.
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Crespo Carballés MJ, Sastre-Ibáñez M, Prieto Del Cura M, Jimeno Anaya L, Pastora N, Quijada Angeli S. Retinal vasoproliferative tumor (Retinal reactive astrocytic tumor). J Fr Ophtalmol 2019; 42:e455-e458. [PMID: 31296349 DOI: 10.1016/j.jfo.2019.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | - M Sastre-Ibáñez
- Service d'ophtalmologie, hôpital universitaire Infanta Leonor, Madrid, Spain.
| | - M Prieto Del Cura
- Service d'ophtalmologie, hôpital universitaire Infanta Leonor, Madrid, Spain
| | - L Jimeno Anaya
- Service d'ophtalmologie, hôpital universitaire Infanta Leonor, Madrid, Spain
| | - N Pastora
- Service d'ophtalmologie, hôpital universitaire Infanta Leonor, Madrid, Spain
| | - S Quijada Angeli
- Service d'ophtalmologie, hôpital universitaire Infanta Leonor, Madrid, Spain
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17
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18
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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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20
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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: 4] [Impact Index Per Article: 0.7] [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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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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22
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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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23
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Singh AD, Soto H, Bellerive C, Biscotti CV. Reactive Retinal Astrocytic Tumor (Focal Nodular Gliosis): Report of the Clinical Spectrum of 3 Cases. Ocul Oncol Pathol 2017; 3:235-239. [PMID: 29071275 DOI: 10.1159/000455151] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/09/2016] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To report 3 cases providing insight into clinical progression of reactive retinal astrocytic tumor. METHODS The clinical, imaging, and when available, the cytologic features of 3 cases of reactive retinal astrocytic tumor (focal nodular gliosis) were reviewed. RESULTS A 6-year-old female, a 49-year-old man, and a 39-year-old man each developed a white retinal mass associated with laser photocoagulation, lattice degeneration, and treatment of a presumed vascular tumor, respectively. All tumors were white, circumscribed retinal masses that tended to be associated with exudation and either initially or eventually minimal vascularity. CONCLUSION Reactive retinal astrocytic tumor can be observed in response to a degenerative, inflammatory, or ischemic retinal insult. Such tumors may progress after therapeutic intervention.
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Affiliation(s)
- Arun D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute, Ohio, USA
| | - Hansell Soto
- Department of Ophthalmic Oncology, Cole Eye Institute, Ohio, USA
| | | | - Charles V Biscotti
- Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.,Department of General Ophthalmology, National Institute of Diabetes, Endocrinology and Nutrition, Santo Domingo, Dominican Republic
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24
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Abstract
OBJECTIVE To evaluate the clinical and histopathologic characteristics of patients who develop proliferative vitreoretinopathy after retinoblastoma treatment. DESIGN Retrospective review of three cases of proliferative vitreoretinopathy (PVR) that developed after successful treatment of retinoblastoma from 2003 to 2015. SUBJECTS Three patients with treated retinoblastoma who developed severe PVR and required enucleation. METHODS Review of clinical charts, fundus drawings, Ret-Cam 3 images, and histopathology specimens. MAIN OUTCOME MEASURES Clinical and histopathologic characterization of PVR in treated retinoblastoma. RESULTS Three patients developed severe PVR after sequential thermal laser combined with systemic chemotherapy for retinoblastoma. At presentation patients were 6, 7, and 9 months of age, and all had bilateral retinoblastoma. Time to development of proliferative tissue was 9, 12, and 20 months after initial treatment. Proliferation was characterized by progressive growth of white vascularized tissue with associated traction on the retina and sometimes hemorrhage. All patients underwent enucleation. Histopathologic evaluation revealed treated retinoblastoma tumor with a Type 3 regression pattern, pre- and subretinal fibrovascular tissue consistent with PVR, and reactive changes in the retinal pigment epithelium. None of the patients developed recurrence of retinoblastoma or systemic metastasis. CONCLUSION PVR uncommonly develops after successful treatment of retinoblastoma and may result in traction or rhegmatogenous retinal detachment along with vitreous hemorrhage. Early stages of proliferation may be difficult to distinguish from recurrent tumor. Enucleation may be required due to poor vision and inability to adequately monitor for tumor recurrence.
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25
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Dewan A, Saran RK, Gupta SN, Arya D, Goel R. Intraocular Ependymoma With Blood-Filled Spaces: Neoplasm or a Reactive Process With Ependymal Differentiation-A Dilemma. Int J Surg Pathol 2017; 25:368-373. [PMID: 28193095 DOI: 10.1177/1066896917692098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intraocular glial lesions are rare and include retinal gliosis, hamartomas, and astrocytomas and rarely ependymomas. Ependymomas are slow-growing glial tumors preferentially arising in the central nervous system (CNS), occasionally presenting at sites outside the CNS, with only 2 cases of primary retinal ependymoma reported till date. We report herein the third such case of a 20-year-old male who presented with a painful blind eye. The enucleated specimen showed presence of a glial tumor with cells arranged in sheets as well as few true rosettes and pseudo-rosettes and an immunohistochemical profile similar to a classical ependymoma at usual sites in the CNS. Additionally, the presence of blood-filled spaces and few proliferating blood vessels made it a diagnostic challenge. All retinal glial lesions are positive for GFAP and S100. Therefore, immunostaining for EMA as well as the MIB-1-labeling index maybe vital in differentiating ependymomas from other intraocular glial lesions.
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Affiliation(s)
- Aditi Dewan
- 1 Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ravindra Kumar Saran
- 1 Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | | | - Ruchi Goel
- 2 Maulana Azad Medical College, New Delhi, India
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26
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Shields CL, Shields JA. The American Society of Retina Specialists 2016 Founders Award Lecture. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/2474126416677898] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To review the current state of the art of retinal tumors with respect to clinical features, imaging, and management. Methods: Review of published literature and personal experience from an ocular oncology service. Results: There are several tumors that arise from the sensory retina including those of glial origin (astrocytic hamartoma, acquired astrocytoma, and solitary circumscribed retinal astrocytic proliferation), neural origin (retinoblastoma), and vascular origin (hemangioblastoma, cavernous hemangioma, racemose hemangioma, and vasoproliferative tumor). Most retinal tumors are benign with the exception of retinoblastoma and retinal metastasis. Some retinal tumors are associated with systemic oculoneurocutaneous syndromes such as tuberous sclerosis complex (TSC), 13q deletion syndrome, Von Hippel–Lindau disease, and systemic cavernous and racemose hemangioma syndromes with ocular, cutaneous, neurologic, and other findings. Regarding management, recent data indicate that retinal astrocytic hamartoma and retinal achromic patch are key to the diagnosis of TSC and imply greater risk for brain and kidney tumors. Some children with TSC respond to mammalian target of rapamycin inhibitors, controlling brain, kidney, and eye tumors. Children with retinoblastoma are all screened genetically, and systemic evaluation is provided for detection of metastasis and secondary-related tumors. Newer chemotherapy regimens by intravenous or intra-arterial routes have revolutionized retinoblastoma control. Retinal vascular tumors are uncommon but can have serious systemic implications. Therefore, imaging of the brain for related cerebellar hemangioblastoma, midbrain racemose hemangioma, or multifocal cavernomas is performed. Genetic testing for each disease can be revealing. Conclusions: Retinal tumors are often benign, can be recognized by clinical and imaging features, and can be associated with important systemic syndromes.
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Affiliation(s)
- Carol L. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry A. Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
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27
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Guffey Johnson J, Margo CE. Intraocular inflammatory mass associated with lens-induced uveitis. Surv Ophthalmol 2017; 62:541-545. [PMID: 28069494 DOI: 10.1016/j.survophthal.2016.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/29/2016] [Accepted: 12/30/2016] [Indexed: 01/30/2023]
Abstract
Intraocular inflammatory tumefactions large enough to simulate neoplasms are uncommon. We report a patient with a large intraocular inflammatory mass composed of cells with features of histiocytes and myofibroblasts that was associated with lens-induced uveitis. The spindle cell mass appears to have arisen as an exaggerated response to exposed lens fibers. Although information from immunohistochemistry and cytogenetics has advanced the classification of inflammatory tumefactions, this case highlights the challenges in establishing the nature of these lesions.
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Affiliation(s)
- Jean Guffey Johnson
- Department of Pathology, James A. Haley Veterans Affairs Hospital, Tampa, Florida, USA
| | - Curtis E Margo
- Department of Pathology and Cell Biology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA; Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
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28
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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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29
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Huang YM, Chen SJ. Clinical characters and treatments of retinal vasoproliferative tumors. Taiwan J Ophthalmol 2016; 6:85-88. [PMID: 29018717 PMCID: PMC5602695 DOI: 10.1016/j.tjo.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 04/05/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022] Open
Abstract
Retinal vasoproliferative tumors (VPT) are uncommon benign vascular tumors. They mostly occur in healthy patients, but may be associated with other chorioretinal diseases. Here we report four patients with VPT at a referral center from 2006 to 2015. Three patients denied any past history and one had a history of retinal detachment surgery. VPT-related complications included epiretinal membrane (ERM) (n = 2), cystoids macular edema (n = 1), and lamellar hole combined with dense cataract, rigid anterior capsule and vitreous opacity (n = 1). Treatments for VPT and comorbidities included vitrectomy (VT) and membrane peeling with tumor resection (n = 2), a combined treatment of photodynamic therapy (PDT) and intravitreal injection (IVI) of anti-vascular endothelial growth factor (anti-VEGF) (n = 2). Tumor shrinkage was achieved in both patients treated with PDT and IVI of anti-VEGF injection. The other two patients with ERM were successfully treated with VT and tumor resection. Visual acuity improved at least two lines in three patients, and one patient had decreased vision due to cataract formation after VT. Pathology of the resected tumor in one case revealed massive gliosis with positive stain of vascular endothelial cells and glial fibrillary acidic protein stain. Yet the peeled membrane was acellular. Possible beneficial treatments for VPT and comorbidities include PDT combined with IVI of anti-VEGF, or VT and membrane peeling with tumor resection.
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Affiliation(s)
- Yi-Ming Huang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.,Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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30
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Jakobiec FA, Thanos A, Stagner AM, Grossniklaus HE, Proia AD. So-called massive retinal gliosis: A critical review and reappraisal. Surv Ophthalmol 2015; 61:339-56. [PMID: 26703887 DOI: 10.1016/j.survophthal.2015.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/16/2022]
Abstract
Massive retinal gliosis, a nonneoplastic retinal glial proliferation, was first described in detail over 25 years ago, before the era of immunohistochemistry, in a series of 38 cases-to which can be added 30 case reports or small series (no more than 3 cases) subsequently. We analyze a new series of 3 nontumoral intraretinal glioses and 15 cases of tumoral retinal gliosis, not all of which, strictly speaking, were massive. The data from this series are compared with the findings in previously published cases. Included are 2 cases of massive retinal gliosis diagnosed from evisceration specimens. In reviewing all published and current cases, we were able to establish 3 subgroups of retinal tumoral glioses rather than a single "massive" category: focal nodular gliosis, submassive gliosis, and massive gliosis. Among 43 reported cases, including the present series, but excluding the previous large series of 38 cases in which substantial clinical data were omitted, there were 19 men and 24 women. Their mean and median ages were 36.2 years and 36 years, respectively, with a range of 2 to 79 years. All lesions were composed of mitotically quiet, compact spindled fibrous astrocytes devoid of an Alcian blue-positive myxoid matrix. The most common associated ocular conditions were phthisis bulbi and congenital diseases or malformations. Histopathologically, all 3 tumoral categories were accompanied by progressively more extensive fibrous and osseous metaplasia of the pigment epithelium, the latter forming a clinically and diagnostically useful, almost continuous, outer rim of eggshell calcification in the submassive and massive categories that should be detectable with appropriate imaging studies. In decreasing order of frequency, microcysts and macrocysts, vascular sclerosis, exudates, calcospherites, and Rosenthal fibers were observed among the proliferating fibrous astrocytes. Immunohistochemistry was positive for glial fibrillary acidic protein in all cases and nestin in most (an intermediate cytoplasmic filament typically restricted to embryonic and reparative neural tissue). The nonneoplastic nature of all categories of gliosis was confirmed by absent TP53 (tumor suppressor gene) dysregulation, Ki-67 negativity, and intact p16 expression (the protein product of the p16 tumor suppressor gene) in the overwhelming majority of cases. These findings indicate an intrinsic attempt to regulate and maintain a low level of glial cell proliferation that becomes unsuccessful as the disease evolves. The categories of tumoral proliferation appeared to constitute a spectrum. We conclude that focal nodular tumors encompass lesions previously called retinal vasoproliferative lesions, which display the same histopathologic and immunohistochemical findings as 3 major categories of retinal gliosis characterized herein.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.
| | - Aristomenis Thanos
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA; Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Hans E Grossniklaus
- L.F. Montgomery Pathology Laboratory, Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia, USA
| | - Alan D Proia
- Department of Pathology, Duke University, Durham, North Carolina, USA; Department of Ophthalmology, Duke University, Durham, North Carolina, USA
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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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Abstract
Astrocytomas arising within the eye display 2 distinct histologies: one comprises interlacing bundles of spindle-shaped cells mixed with a minority of polygonal cells, and the other consists of large cells with abundant glassy cytoplasm (gemistocytic astrocytes) indistinguishable from cells found in subependymal giant cell astrocytoma. Both histologic patterns express glial fibrillary acid protein diffusely, are biologically benign, and are frequently associated with dysgenic syndromes, particularly tuberous sclerosis complex. Tumors with gemistocytes, however, demonstrate a greater propensity for invasive growth. The clinical history may provide information to guide the pathologist in distinguishing intraocular astrocytoma from reactive astrocytosis, conditions that are histologically similar. It remains to be determined if other types of primary intraocular glioma exist or whether some degree of ependymal or oligodendroglial differentiation can accompany reactive astrocytosis.
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Affiliation(s)
- Allen Pusateri
- From the Department of Pathology and Molecular Biology, Morsani College of Medicine, University of South Florida, Tampa (Dr Margo). Dr Pusateri is a resident in training at the Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa
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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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Shields JA, Shields CL. Reactive retinal astrocytic tumors (so-called vasoproliferative tumors): histopathologic, immunohistochemical, and genetic studies of four cases. Am J Ophthalmol 2013; 156:202-3. [PMID: 23791372 DOI: 10.1016/j.ajo.2013.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 02/17/2013] [Accepted: 03/11/2013] [Indexed: 10/26/2022]
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