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Daniels AB, Chang EY, Chew EY, Gombos DS, Gorin MB, Shields CL, Wiley HE. Consensus Guidelines for Ocular Surveillance of von Hippel-Lindau Disease. Ophthalmology 2024; 131:622-633. [PMID: 38092079 DOI: 10.1016/j.ophtha.2023.12.014] [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] [Received: 03/04/2022] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 03/21/2024] Open
Abstract
PURPOSE To develop guidelines for ocular surveillance and early intervention for individuals with von Hippel-Lindau (VHL) disease. DESIGN Systematic review of the literature. PARTICIPANTS Expert panel of retina specialists and ocular oncologists. METHODS A consortium of experts on clinical management of all-organ aspects of VHL disease was convened. Working groups with expertise in organ-specific features of VHL disease were tasked with development of evidence-based guidelines for each organ system. The ophthalmology subcommittee formulated questions for consideration and performed a systematic literature review. Evidence was graded for topic quality and relevance and the strength of each recommendation, and guideline recommendations were developed. RESULTS The quality of evidence was limited, and no controlled clinical trial data were available. Consensus guidelines included: (1) individuals with known or suspected VHL disease should undergo periodic ocular screening (evidence type, III; evidence strength, C; degree of consensus, 2A); (2) patients at risk of VHL disease, including first-degree relatives of patients with known VHL disease, or any patient with single or multifocal retinal hemangioblastomas (RHs), should undergo genetic testing for pathologic VHL disease gene variants as part of an appropriate medical evaluation (III/C/2A); (3) ocular screening should begin within 12 months after birth and continue throughout life (III/C/2A); (4) ocular screening should occur approximately every 6 to 12 months until 30 years of age and then at least yearly thereafter (III/C-D/2A); (5) ocular screening should be performed before a planned pregnancy and every 6 to 12 months during pregnancy (IV/D/2A); (6) ultra-widefield color fundus photography may be helpful in certain circumstances to monitor RHs, and ultra-widefield fluorescein angiography may be helpful in certain circumstances to detect small RHs (IV/D/2A); (7) patients should be managed, whenever possible, by those with subspecialty training, with experience with VHL disease or RHs, or with both and ideally within the context of a multidisciplinary center capable of providing multiorgan surveillance and access to genetic testing (IV/D/2A); (8) extramacular or extrapapillary RHs should be treated promptly (III/C/2A). CONCLUSIONS Based on available evidence from observational studies, broad agreement was reached for a strategy of lifelong surveillance and early treatment for ocular VHL disease. These guidelines were endorsed by the VHL Alliance and the International Society of Ocular Oncology and were approved by the American Academy of Ophthalmology Board of Trustees. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, and Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee.
| | | | - Emily Y Chew
- Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland
| | - Dan S Gombos
- Section of Ophthalmology, Department of Head & Neck Surgery, Division of Surgery, University of Texas-MD Anderson Cancer Center, Houston, Texas
| | - Michael B Gorin
- Jules Stein Eye Institute, University of California-Los Angeles School of Medicine, Los Angeles, California
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
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Grimes JM, Gershkovich A, Bogomolny D, Marr BP. TWO CASES OF VON HIPPEL-LINDAU SYNDROME-ASSOCIATED RETINAL HEMANGIOBLASTOMA TREATED WITH BELZUTIFAN. Retin Cases Brief Rep 2024; 18:319-322. [PMID: 36730578 DOI: 10.1097/icb.0000000000001376] [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: 02/04/2023]
Abstract
PURPOSE To describe two cases of retinal hemangioblastoma regression following treatment with belzutifan in patients with von Hippel-Lindau syndrome. METHODS Clinical information was extracted from the charts and tumor imaging of two patients with von Hippel-Lindau-associated retinal hemangioblastoma. RESULTS In Case 1, a 40-year-old man was treated with belzutifan for spine hemangioblastomas after diagnosis of a 2.0 × 2.0 × 1.3 mm left-eye retinal hemangioblastoma temporal to the macula associated with intraretinal edema, subretinal fluid, and mild retinal traction. In Case 2, a 66-year-old woman presented with a right eye 2.0 × 1.5 × 1.3 mm juxtapapillary lesion with subretinal fluid, intraretinal fluid, and nasal traction, and a 4.0 × 3.5 × 1.1 mm inferior midperiphery lesion with subretinal fluid, intraretinal fluid, and active exudation. She was treated for 2.5 years with belzutifan for renal cell carcinoma on the National Institutes of Health trial. The patient in case 1 demonstrated a 10% reduction in largest tumor diameter and 8% reduction in thickness, along with improving subretinal fluid, intraretinal edema, and retinal traction, after 4 weeks of treatment. After 2.5 years of treatment, the patient in Case 2 demonstrated similar margins of her now fibrotic-appearing juxtapapillary lesion with a 45% reduction in thickness, along with resolved subretinal fluid and greatly improved intraretinal fluid and traction. The inferior lesion demonstrated 12.5% reduction in largest diameter, 36% reduction in thickness, and was without active subretinal fluid or exudation. Neither patient demonstrated new lesions while on treatment. CONCLUSION Belzutifan is a promising treatment for retinal hemangioblastoma with the potential for both rapid and sustained tumor regression.
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Affiliation(s)
- Joseph M Grimes
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
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Daniels AB, Tirosh A, Huntoon K, Mehta GU, Spiess PE, Friedman DL, Waguespack SG, Kilkelly JE, Rednam S, Pruthi S, Jonasch EA, Baum L, Chahoud J. Guidelines for surveillance of patients with von Hippel-Lindau disease: Consensus statement of the International VHL Surveillance Guidelines Consortium and VHL Alliance. Cancer 2023; 129:2927-2940. [PMID: 37337409 DOI: 10.1002/cncr.34896] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/17/2023] [Accepted: 04/26/2023] [Indexed: 06/21/2023]
Abstract
Von Hippel‐Lindau disease is a rare inherited cancer‐predisposition syndrome. The authors report the updated recommendations for the multiorgan surveillance protocols.
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Affiliation(s)
- Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology & Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amit Tirosh
- Neuroendocrine Tumors Service, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kristin Huntoon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Tennessee, USA
| | | | - Philippe E Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Debra L Friedman
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Texas, USA
| | - Steven G Waguespack
- Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jill E Kilkelly
- Division of Pediatric Anesthesia, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Surya Rednam
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Sumit Pruthi
- Division of Pediatric Neuroradiology, Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric A Jonasch
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura Baum
- Division of Hematology/Oncology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida, USA
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Lee SH, Park KH, Woo SJ, Park SJ, Joo K. Clinical and Genetic Characteristics of Retinal Capillary Hemangioblastoma in Korean Patients. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:543-549. [PMID: 36281577 DOI: 10.3341/kjo.2022.0079] [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: 06/15/2022] [Accepted: 10/17/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We investigated the clinical features of Korean patients with retinal capillary hemangioblastoma (RCH) and genetic variants of the von Hippel-Lindau (VHL) gene. METHODS A retrospective analysis was performed on patients with RCH from 2003 to 2021 at Seoul National University Bundang Hospital. Sporadic and hereditary RCH associated with VHL disease were classified based on the specific tumors and family history. Clinical features, including the location and number of RCH and bilateral involvement, were investigated. Multiplex ligation-dependent probe amplification and direct sequencing targeting the VHL gene were performed for six RCH cases associated with VHL disease. RESULTS A total of 18 patients (23 eyes) were enrolled in this study. The mean age at diagnosis was 37 ± 15 years. Twelve patients had hereditary RCH associated with VHL disease, and six patients had sporadic RCH. All five patients with bilateral RCH were clinically diagnosed with VHL disease, and 13 patients had unilateral RCH. Juxtapapillary RCH was only observed in patients with VHL. The most common complication of RCH was the epiretinal membrane, followed by the subretinal fluid. Pathogenic variants were identified in four patients. All three patients with type 1 VHL had the well-known missense mutation p.Glu70Lys, and one patient with type 2 VHL had the nonsense mutation p.Trp88Ter. CONCLUSIONS In Korean patients with RCH, bilateral involvement and juxtapapillary RCH are highly likely to be associated with VHL disease. Because RCH may be the first clinical manifestation in patients with VHL, active genetic testing of the VHL gene and systemic evaluation are required.
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Affiliation(s)
- Sang Ha Lee
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kwangsic Joo
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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von Hippel-Lindau disease: Updated guideline for diagnosis and surveillance. Eur J Med Genet 2022; 65:104538. [PMID: 35709961 DOI: 10.1016/j.ejmg.2022.104538] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/29/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
Abstract
von Hippel Lindau disease (vHL) is caused by a hereditary predisposition to multiple neoplasms, especially hemangioblastomas in the retina and CNS, renal cell carcinomas (RCC), pheochromocytomas, neuroendocrine pancreatic tumours (PNET) and endolymphatic sac tumours. Evidence based approaches are needed to ensure an optimal clinical care, while minimizing the burden for the patients and their families. This guideline is based on evidence from the international vHL literature and extensive research of geno- and phenotypic characteristics, disease progression and surveillance effect in the national Danish vHL cohort. We included the views and preferences of the Danish vHL patients, ensured consensus among Danish experts and compared with international recommendations. RECOMMENDATIONS: vHL can be diagnosed on clinical criteria, only; however, in most cases the diagnosis can be supported by identification of a pathogenic or likely pathogenic variant in VHL. Surveillance should be initiated in childhood in persons with, or at risk of, vHL, and include regular examination of the retina, CNS, inner ear, kidneys, neuroendocrine glands, and pancreas. Treatment of vHL manifestations should be planned to optimize the chance of cure, without unnecessary sequelae. Most manifestations are currently treated by surgery. However, belzutifan, that targets HIF-2α was recently approved by the U.S. Food and Drug Administration (FDA) for adult patients with vHL-associated RCC, CNS hemangioblastomas, or PNETs, not requiring immediate surgery. Diagnostics, surveillance, and treatment of vHL can be undertaken successfully by experts collaborating in multidisciplinary teams. Systematic registration, collaboration with patient organisations, and research are fundamental for the continuous improvement of clinical care and optimization of outcome with minimal patient inconvenience.
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Photodynamic Therapy for Retinal Hemangioblastoma: Treatment Outcomes of 17 Consecutive Patients. Ophthalmol Retina 2021; 6:80-88. [PMID: 33892136 DOI: 10.1016/j.oret.2021.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the efficacy of photodynamic therapy (PDT) for management of retinal hemangioblastoma. DESIGN Retrospective case series. PARTICIPANTS Seventeen patients with retinal hemangioblastoma treated with PDT. METHODS The medical records of 17 patients with retinal hemangioblastoma treated with PDT were reviewed, and treatment outcomes were assessed. Photodynamic therapy was performed with 6 mg/m2 body surface area of verteporfin infused intravenously over 10 minutes activated by 50 J/cm2 laser light at 689 nm for 83 or 166 seconds. MAIN OUTCOME MEASURES Tumor control, subretinal and intraretinal fluid resolution, and visual outcome. RESULTS Eighteen retinal hemangioblastomas in 17 eyes were treated with PDT. Median patient age was 31 years (mean, 36 years; range, 7-66 years), and median follow-up was 51 months (mean, 61 months; range, 2-144 months). Genetic testing confirmed von Hippel-Lindau disease in 8 of 17 patients (47%). The tumors were unilateral in all patients and unifocal in most patients (n = 13/17 [76%]). The tumor median basal diameter was 3.5 mm (mean, 3.4 mm; range, 1.5-6.0 mm) and median thickness was 2.1 mm (mean, 2.3 mm; range, 1.0-5.0 mm). The tumor location was juxtapapillary in 9 of 18 cases (50%). Associated findings included subretinal fluid (n = 14/17 [82%]) and macular edema (n = 12/17 [71%]). The median number of PDT sessions was 1.5 (mean, 1.8; range, 1.0-4.0). Standard duration of PDT (83 seconds) was used in all cases except 2, in which double duration (166 seconds) was used. Outcomes revealed tumor control in 13 of 18 tumors (72%), partial or complete resolution of subretinal fluid in 10 of 14 eyes (71%), and partial or complete resolution of macular edema in 7 of 12 eyes (58%), and stable or improved visual acuity in 12 of 17 eyes (71%). Photodynamic therapy-related transient exudative response was noted in 4 of 17 eyes (24%). CONCLUSIONS Photodynamic therapy is an effective treatment for both juxtapapillary and peripheral retinal hemangioblastomas, providing satisfactory rates of tumor control and visual stabilization and improvement. Patients should be monitored for PDT-related transient exudative response.
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Khan HA, Shahzad MA, Iqbal F, Awan MA, Khan QA, Saatci AO, Abbass A, Hussain F, Hussain SA, Ali A, Ali W. Ophthalmological Aspects of von-Hippel-Lindau Syndrome. Semin Ophthalmol 2021; 36:531-540. [PMID: 33780299 DOI: 10.1080/08820538.2021.1897851] [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: von Hippel-Lindau (VHL) syndrome is a multisystem neoplastic disorder involving eyes, central nervous system, kidneys, spine, and other tissues. A retinal capillary hemangioma (RCH) is the earliest manifestation of the VHL disease in most cases.Areas covered:This paper aims to provide an up-to-date review of the current literature about von Hippel-Lindau syndrome. Molecular background, systemic and ocular features of the diseases as well as the utility of newer imaging modalities in diagnosis and monitoring of ocular VHL disease have been described. Besides, we have discussed newer treatment modalities and therapeutic targets.Conclusion: Modern imaging technologies like optical coherence tomography and optical coherence tomography angiography are tools of the trade, in making an appropriate diagnosis and monitoring disease activity and response to treatment. Peripheral RCH may be treated using laser photocoagulation in tumors up to 3000 µm. Vascular endothelial growth factor suppression can help in reducing tumor activity and stabilize the tumor size; however, it does not regress the RCH.
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Affiliation(s)
- Hashim Ali Khan
- Ophthalmology department, SEHHAT Foundation Hospital, Danyore, Gilgit, Pakistan.,School of Optometry & Department of Ophthalmology, The University of Faisalabad, Faisalabad, Pakistan
| | | | - Fatima Iqbal
- School of Optometry & Department of Ophthalmology, The University of Faisalabad, Faisalabad, Pakistan.,School of Optometry and Vision Science - University of New South Wale, Sydney, Australia
| | - Muhammad Amer Awan
- Ophthalmology department, Shifa College of Medicine, Islamabad, Pakistan
| | - Qaim Ali Khan
- Ophthalmology department, Punch Medical College, AJK, Pakistan
| | | | - Ahmed Abbass
- Ophthalmology department, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Fazil Hussain
- Department of General Medicine PHQ Hospital, Gilgit, Pakistan
| | - Syed Arif Hussain
- Neurosurgery department, Pakistan Institute of Medical Science (PIMS), Islamabad, Pakistan
| | - Atif Ali
- Department of Acute Medicine, Luton & Dunstable Hospital, Luton, UK
| | - Wajahat Ali
- Department of Internal Medicine, King's Mill Hospital, Sutton-in-Ashfield, Nottinghamshire, UK
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Mitamura M, Kase S, Hirooka K, Ishida S. Laser speckle flowgraphy in juxtapapillary retinal capillary hemangioblastoma: a case report on natural course and therapeutic effect. Oncotarget 2020; 11:3800-3804. [PMID: 33144921 PMCID: PMC7584241 DOI: 10.18632/oncotarget.27771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/29/2020] [Indexed: 12/04/2022] Open
Abstract
Juxtapapillary retinal capillary hemangioblastoma (JRCH), a benign intraocular vascular tumor, is usually progressive and may lead to severe vision loss due to various complications. We herein present a case of JRCH observed with laser speckle flowgraphy (LSFG) before and after laser photocoagulation (LPC). A 21-year-old Japanese woman underwent LSFG evaluations. Right eye showed an orange-colored tumor consistent with JRCH on the papillomacular bundle, where LSFG showed a mild warm-color blood flow signal. Eight months after the first examination, JRCH in the right eye increased redness with vasodilatation, and the size enlarged, where LSFG showed a stronger warm-color blood flow signal. She underwent direct yellow laser ablation for the JRCH lesion. One week after LPC, JRCH became paler and LSFG eventually depicted a weakened blood flow signal at the same site. In conclusion, non-invasive and reproducible LSFG is a useful tool for assessing not only JRCH activity but also therapeutic effect.
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Affiliation(s)
- Mizuho Mitamura
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Department of Ophthalmology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoru Kase
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kiriko Hirooka
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Mazloumi M, Dalvin LA, Abtahi SH, Yavari N, Yaghy A, Mashayekhi A, Shields JA, Shields CL. Photodynamic Therapy in Ocular Oncology. J Ophthalmic Vis Res 2020; 15:547-558. [PMID: 33133446 PMCID: PMC7591845 DOI: 10.18502/jovr.v15i4.7793] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 01/10/2023] Open
Abstract
Over the past two decades, we have witnessed the increasing use of photodynamic therapy (PDT) in the field of ocular oncology. Based on a review of the literature and our own experience, we herein review the role of PDT for the management of intraocular tumors. The discussion includes two main topics. First, we discuss the application of PDT for benign tumors, including circumscribed choroidal hemangioma, choroidal osteoma, retinal astrocytoma, retinal capillary hemangioma (retinal hemangioblastoma), and retinal vasoproliferative tumor. Second, we assess the role of PDT for malignant tumors, including choroidal melanoma and choroidal metastasis.
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Affiliation(s)
- Mehdi Mazloumi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | | | - Seyed-Hossein Abtahi
- Isfahan Eye Research Center, Feiz Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negin Yavari
- Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Jerry A Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, USA
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Abstract
PURPOSE To provide an update summarizing the biologic pathways governing von Hippel-Lindau (VHL) disease pathogenesis and to provide an overview of systemic manifestations as well as screening recommendations. METHODS A PubMed search of the English language literature was reviewed using the following search terms: von Hippel-Lindau, von Hippel-Lindau disease, and VHL. Of 6,696 publications, the most current and pertinent information related to the pathogenesis and systemic aspects of VHL disease were included in this review. RESULTS von Hippel-Lindau disease is one of the most frequently occurring multisystem familial cancer syndromes. The disease results from germline mutation in the VHL tumor suppressor gene on the short arm of chromosome 3. Mutation in the VHL gene affects multiple cellular processes including transcriptional regulation, extracellular matrix formation, apoptosis, and, in particular, the cellular adaptive response to hypoxia. As a result, there is widespread development of vascular tumors affecting the retina, brain, and spine, as well as a spectrum of benign and malignant tumors and/or cysts in visceral organs. CONCLUSION The ophthalmologist plays a key role in VHL disease diagnosis, as retinal hemangioblastoma is frequently the first disease manifestation. Screening guidelines for individuals with known VHL disease, and those at risk of VHL disease, help to ensure early detection of potentially vision-threatening and life-threatening disease.
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Wiley HE, Krivosic V, Gaudric A, Gorin MB, Shields C, Shields J, Aronow ME, Chew EY. MANAGEMENT OF RETINAL HEMANGIOBLASTOMA IN VON HIPPEL-LINDAU DISEASE. Retina 2019; 39:2254-2263. [PMID: 31259811 PMCID: PMC6878154 DOI: 10.1097/iae.0000000000002572] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To review the current state of diagnosis and management of retinal hemangioblastoma and retinal vascular proliferation arising from von Hippel-Lindau (VHL) disease. METHODS A review of the literature was performed. Consensus was reached among authors regarding current practice, with reference to published data where possible. RESULTS von Hippel-Lindau disease and its ocular manifestations are relatively rare, and there is limited evidence in the literature on which to base management. There was consensus on core principles, including 1) recognition and diagnosis of von Hippel-Lindau disease when present, with appropriate referral for care of this potentially lethal systemic condition; 2) regular ophthalmic evaluation for individuals with von Hippel-Lindau disease, to identify and offer timely treatment for new or active retinal hemangioblastomas; 3) ablative treatment of retinal hemangioblastomas that can be safely destroyed, to lower risk of vision loss; 4) observation or consideration of nonablative treatments for retinal hemangioblastomas that cannot be safely destroyed; and 5) observation of asymptomatic retinal vascular proliferation, with consideration of vitrectomy for lesions exerting effects on vision. CONCLUSION Ocular outcomes can be gratifying in many cases with appropriate management. Improved understanding of the molecular basis for the disease creates an opportunity for rational design of better therapies.
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Affiliation(s)
- Henry E. Wiley
- National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Valerie Krivosic
- Service d'Opthalmologie, APHP, Hôpital Lariboisière, Université Paris-Diderot, Sorbonne Paris Cité. France
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'OEil (CERVCO), Hôpital Lariboisière, APHP, Paris, France
| | - Alain Gaudric
- Service d'Opthalmologie, APHP, Hôpital Lariboisière, Université Paris-Diderot, Sorbonne Paris Cité. France
- Centre de Référence des Maladies Vasculaires Rares du Cerveau et de l'OEil (CERVCO), Hôpital Lariboisière, APHP, Paris, France
| | - Michael B. Gorin
- Jules Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Carol Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Jerry Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Mary E. Aronow
- Ocular Oncology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Emily Y. Chew
- National Eye Institute, National Institutes of Health, Bethesda, MD
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Golas L, Skondra D, Ittiara S, Bajic N, Jeng-Miller KW, Mukai S, Yonekawa Y, Blair MP. Efficacy of Retinal Lesion Screening in Von Hippel-Lindau Patients With Widefield Color Fundus Imaging Versus Widefield FA. Ophthalmic Surg Lasers Imaging Retina 2019; 50:e260-e265. [DOI: 10.3928/23258160-20191031-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 03/22/2019] [Indexed: 01/26/2023]
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DeSouza PJ, Shah RE. Retinal Capillary Hemangioblastomas in a Parent and Child With von Hippel-Lindau Disease. JAMA Ophthalmol 2019; 137:e186508. [PMID: 30869764 DOI: 10.1001/jamaophthalmol.2018.6508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Philip J DeSouza
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Rajiv E Shah
- Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Solitary retinal hemangioblastoma findings in OCTA pre- and post-laser therapy. Am J Ophthalmol Case Rep 2018; 10:59-61. [PMID: 29780915 PMCID: PMC5956628 DOI: 10.1016/j.ajoc.2018.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 01/13/2018] [Accepted: 01/19/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To report optical coherence tomography angiography (OCTA) findings pre- and post-thermal laser therapy of a rare, asymptomatic, unilateral, isolated retinal hemangioblastoma. Observations A 40-year-old asymptomatic Caucasian man was found to have an isolated, unilateral retinal hemangioblastoma after referral for possible retinal hole. Comparison of OCTAs pre- and post-thermal laser therapy demonstrated a significant reduction of blood flow toward and within the lesion, in addition to contraction of the lesion and constriction of the accompanying feeder vessels. A 4-month follow-up OCTA showed marked reduction of lesion size, and caliber of treated vessels. Conclusions and importance Non-invasive OCTA imaging of a retinal hemangioblastoma demonstrated decreased blood flow signal and vessel caliber after treatment. OCTA shows potential as a new tool to improve our understanding of the effectiveness of therapy in these lesions.
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Khetan V, Jain M. Commentary: Comparison of optical coherence tomography angiography and fundus fluorescein angiography features of retinal capillary hemangioblastoma. Indian J Ophthalmol 2018; 66:876-877. [PMID: 29786010 PMCID: PMC5989524 DOI: 10.4103/ijo.ijo_301_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Crespigio J, Berbel LCL, Dias MA, Berbel RF, Pereira SS, Pignatelli D, Mazzuco TL. Von Hippel-Lindau disease: a single gene, several hereditary tumors. J Endocrinol Invest 2018; 41:21-31. [PMID: 28589383 DOI: 10.1007/s40618-017-0683-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 04/30/2017] [Indexed: 12/27/2022]
Abstract
The Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder characterized by the predisposition for multiple tumors caused by germline mutations in the tumor suppressor gene VHL. This disease is associated with a high morbidity and mortality and presents a variable expression, with different phenotypes from family to family, affecting different organs during the lifetime. The main manifestations of VHL are hemangioblastomas of the central nervous system and retina, renal carcinomas and cysts, bilateral pheochromocytomas, cystic and solid tumors of the pancreas, cystadenomas of the epididymis, and endolymphatic sac tumors. The discovery of any of the syndrome components should raise suspicion of this disease and other stigmas must then be investigated. Due to the complexities associated with management of the various VHL manifestation, the diagnosis and the follow-up of this syndrome is a challenge in the clinical practice and a multidisciplinary approach is needed. The particular relevance to endocrinologists is the detection of pheochromocytomas in 35% and islet cell tumors in 17% of VHL patients, which can be associated with hypertension, hypoglycemia, cardiac arrhythmias, and carcinoid syndrome. The purpose of this review is to define the Von Hippel-Lindau syndrome addressing its clinical aspects and classification, the importance of genetic counseling and to propose a protocol for clinical follow-up.
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Affiliation(s)
- J Crespigio
- Endocrine Interactions Research Group, Diretório dos Grupos de Pesquisa no Brasil (DGP/CNPq), Londrina, Brazil
- Post-graduation Program of Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - L C L Berbel
- Endocrine Interactions Research Group, Diretório dos Grupos de Pesquisa no Brasil (DGP/CNPq), Londrina, Brazil
- Post-graduation Program of Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
- Division of Endocrinology of Medical Clinical Department, University Hospital, UEL, Londrina, Brazil
| | - M A Dias
- Endocrine Interactions Research Group, Diretório dos Grupos de Pesquisa no Brasil (DGP/CNPq), Londrina, Brazil
| | - R F Berbel
- Post-graduation Program of Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
| | - S S Pereira
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
- Clinical and Experimental Endocrinology, Department of Anatomy, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto, Porto, Portugal
| | - D Pignatelli
- Endocrine Interactions Research Group, Diretório dos Grupos de Pesquisa no Brasil (DGP/CNPq), Londrina, Brazil.
- Instituto de Investigação e Inovação em Saúde (I3S), Universidade do Porto, Porto, Portugal.
- Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal.
- Department of Endocrinology, Hospital S.João, Porto, Portugal.
| | - T L Mazzuco
- Endocrine Interactions Research Group, Diretório dos Grupos de Pesquisa no Brasil (DGP/CNPq), Londrina, Brazil
- Post-graduation Program of Health Sciences, Universidade Estadual de Londrina (UEL), Londrina, Brazil
- Division of Endocrinology of Medical Clinical Department, University Hospital, UEL, Londrina, Brazil
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Kavinga Gunawardane PT, Grossman A. The clinical genetics of phaeochromocytoma and paraganglioma. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2017; 61:490-500. [PMID: 29166454 PMCID: PMC10522248 DOI: 10.1590/2359-3997000000299] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 11/22/2022]
Abstract
Phaeochromocytoma and paraganglioma are rare catecholamine-producing tumours, recognised to have one of the richest hereditary backgrounds of all neoplasms, with germline mutations seen in approximately 30% of patients. They can be a part of genetic syndromes such as MEN 2 or Neurofibromatosis type 1, or can be found as apparently sporadic tumours. Germline mutations are almost always found in syndromic patients. Nonetheless, apparently sporadic phaeochromocytoma too show high germline mutation rates. Early detection of a genetic mutation can lead to early diagnosis of further tumours via surveillance, early treatment and better prognosis. Apart from this, the genetic profile has important relevance for tumour location and biochemical profile, and can be a useful predictor of future tumour behaviour. It also enables family screening and surveillance. Moreover, recent studies have demonstrated significant driver somatic mutations in up to 75% of all tumours. Arch Endocrinol Metab. 2017;61(5):490-500.
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Affiliation(s)
- P. T. Kavinga Gunawardane
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordUKOxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
| | - Ashley Grossman
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordUKOxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK
- Green Templeton CollegeUniversity of OxfordUKGreen Templeton College, University of Oxford, UK
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Binderup MLM, Stendell AS, Galanakis M, Møller HU, Kiilgaard JF, Bisgaard ML. Retinal hemangioblastoma: prevalence, incidence and frequency of underlying von Hippel-Lindau disease. Br J Ophthalmol 2017; 102:942-947. [DOI: 10.1136/bjophthalmol-2017-310884] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/15/2017] [Accepted: 09/09/2017] [Indexed: 12/15/2022]
Abstract
Background and aimsWe aimed to determine the frequency of von Hippel-Lindau disease (vHL) as the underlying cause of retinal hemangioblastoma and to estimate retinal hemangioblastoma incidence and prevalence in a national cohort study.MethodsThrough the national patient register and vHL research database, we identified 81 patients diagnosed with a retinal hemangioblastoma in Denmark between 1977 and 2014. Consent was obtained for 54 living and 10 deceased patients with retinal hemangioblastoma. For each participant, we collected medical records and family information. Almost all (63 of 64) participants were or had previously been tested for mutations in the VHL gene.ResultsOverall, 84% of the participants (54 of the 64) had vHL. Compared with the non-vHL patients, the vHL patients had their first retinal hemangioblastoma at a younger age (22.5 vs 40 years), and were more likely to have an asymptomatic first hemangioblastoma (80% vs 20%). Overall, 76% (41 of 54) of the vHL patients had a family history of vHL, while none of the patients without vHL did. Despite the rarity of the disease, on average more than eight new tumours are diagnosed each year due to multiple tumour development in vHL patients. The estimated prevalence of patients with retinal hemangioblastoma was up to 1 in 73 080 individuals.ConclusionIn the first national study in which almost all participants were genetically tested, vHL was the underlying cause of retinal hemangioblastoma in 84% of cases; more often than previously reported. We recommend that genetic and clinical vHL screening should be performed in all patients with retinal hemangioblastoma.
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Launbjerg K, Bache I, Galanakis M, Bisgaard ML, Binderup MLM. von Hippel-Lindau development in children and adolescents. Am J Med Genet A 2017. [PMID: 28650583 DOI: 10.1002/ajmg.a.38324] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The autosomal dominant von Hippel-Lindau disease (vHL) is associated with a lifelong risk of tumor development, especially retinal and CNS hemangioblastomas, pheochromocytoma, and renal cell carcinoma. Knowledge of paediatric vHL development is limited, and current surveillance guidelines are based on expert opinions. We aimed to describe the course of vHL development in children and adolescents, focusing on age at first manifestation, manifestation frequencies, and types. The prevalence of vHL diagnosis as well as manifestations in childhood were evaluated based on 99 patients, who had started surveillance before 18 years: 37 Danish patients from the national vHL research database and 62 international patients reported in 15 articles. Overall, 70% (69 of 99) developed manifestations before 18 years (median age at first manifestation: 12 years (range: 6-17 years)). Thirty per cent (30 of 99) had developed more than one manifestation type; the most frequent were retinal (34%) and CNS (30%) hemangioblastomas. Among the 37 Danish patients, 85% (97 of 116) of their tumors were asymptomatic. Vision outcome is significantly improved in hemangioblastomas that are treated while still asymptomatic. We agree with current guidelines that retinal surveillance be performed from birth. The patients had their first CNS hemangioblastomas at the median ages of 13-14 years (range: 6-17 years). Further, 11% (4 of 37) of the Danish patients had CNS surgery in their teenage years. Although the cohort is too small to make definite conclusions about specific initiation ages, regular CNS surveillance from vHL patients' teenage years seems clinically relevant.
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Affiliation(s)
- Karoline Launbjerg
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Iben Bache
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, Denmark.,Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | - Michael Galanakis
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Marie Luise Bisgaard
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, Denmark
| | - Marie Louise M Binderup
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen N, Denmark
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Laser Photocoagulation for Peripheral Retinal Capillary Hemangioblastoma in von Hippel-Lindau Disease. ACTA ACUST UNITED AC 2017; 1:59-67. [DOI: 10.1016/j.oret.2016.08.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 08/11/2016] [Accepted: 08/14/2016] [Indexed: 11/24/2022]
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Abstract
Vascular tumors of the retina and choroid can be seen occasionally. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.
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Affiliation(s)
| | - Rajesh Ramanjulu
- Vitreo-retina and Ocular Oncology, Sankara Eye Hospital, Bengaluru, Karnataka, India
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23
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Capuano V, Miere A, Amoroso F, Todisco L, Cohen SY, Souied E, Querques G. Uncommon retinal vascular diseases. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1251315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Photodynamic therapy for juxtapapillary retinal capillary hemangioma. Case Rep Ophthalmol Med 2014; 2014:756840. [PMID: 24716060 PMCID: PMC3971562 DOI: 10.1155/2014/756840] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/01/2014] [Indexed: 11/17/2022] Open
Abstract
Various treatment modalities have been described for retinal capillary hemangioma. Our purpose is to present a case of juxtapapillary retinal capillary hemangioma treated with photodynamic therapy. A 69-year-old woman with no previous ocular history presented with blurred vision and photopsias in the right eye three months ago. At presentation, her best corrected visual acuity was 6/9 in the right eye and 6/6 in the left eye. The anterior segment was totally normal and IOP was normal in both eyes as well. Dilated fundoscopy revealed a yellowish, well-circumscribed, elevated area with blood vessels, on the inferior margin of the right optic disc, as optic disc edema. Fluorescein angiography and angiogram with indocyanine green confirmed the diagnosis of juxtapapillary retinal capillary hemangioma. The patient was treated with photodynamic therapy with verteporfin and three months later her visual acuity was 6/7.5 in the right eye, while the lesion was slightly smaller. These findings remained stable at the one-year follow-up. In conclusion, photodynamic therapy offers promising anatomical and functional results for juxtapapillary retinal capillary hemangioma, providing visual acuity improvement or even stabilization and restriction of enlargement of the lesion.
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Kruizinga RC, Sluiter WJ, de Vries EGE, Zonnenberg BA, Lips CJ, van der Horst-Schrivers ANA, Walenkamp AME, Links TP. Calculating optimal surveillance for detection of von Hippel-Lindau-related manifestations. Endocr Relat Cancer 2014; 21:63-71. [PMID: 24132471 DOI: 10.1530/erc-13-0308] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
von Hippel-Lindau (VHL) mutation carriers develop benign and malignant tumors, requiring regular surveillance. The aim of this study was to calculate the optimal organ-specific age to initiate surveillance and optimal intervals to detect initial and subsequent VHL-related manifestations. In this study, we compare these results with the current VHL surveillance guidelines. We collected data from 82 VHL mutation carriers in the Dutch VHL surveillance program. The cumulative proportion of carriers diagnosed with a first VHL-related manifestation was estimated by the Kaplan-Meier method. The Poisson distribution model was used to calculate average time to detection of the first VHL-related manifestation and subsequent manifestations. We used this to calculate the optimal organ-specific age to initiate surveillance and the surveillance interval that results in a detection probability of 5%. The calculated organ-specific ages to initiate surveillance were 0 years (birth) for adrenal glands, 7 years for the retina, 14 years for the cerebellum, 15 years for the spinal cord, 16 years for pancreas, and 18 years for the kidneys. The calculated surveillance intervals were 4 years for the adrenal glands, biennially for the retina and pancreas, and annually for the cerebellum, spinal cord, and kidneys. Compared with current VHL guidelines, the calculated starting age of surveillance was 6 years later for the retina and 5 years earlier for adrenal glands. The surveillance intervals were two times longer for the retina and four times longer for the adrenal glands. To attain a 5% detection probability rate per organ, our mathematical model indicates that several modifications of current VHL surveillance guidelines should be considered.
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Affiliation(s)
- Roeliene C Kruizinga
- Departments of Medical Oncology Endocrinology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Bamps S, Calenbergh FV, Vleeschouwer SD, Loon JV, Sciot R, Legius E, Goffin J. What the neurosurgeon should know about hemangioblastoma, both sporadic and in Von Hippel-Lindau disease: A literature review. Surg Neurol Int 2013; 4:145. [PMID: 24340227 PMCID: PMC3841920 DOI: 10.4103/2152-7806.121110] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/28/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hemangioblastomas are associated with Von Hippel-Lindau disease (VHLD) in 10-40% of cases. Based upon a literature review we state the core features the neurosurgeon should be aware of. METHODS We performed a selective literature (Cochrane and Medline) search for hemangioblastoma, both sporadic and VHL associated. We reviewed general characteristics (epidemiology, symptomatology, diagnosis, and management) and focused on follow-up as well as screening modalities for sporadic and VHL associated lesions. RESULTS Based upon our literature search, we established guidelines for screening and follow-up in both sporadic and VHL associated hemangioblastoma patients. CONCLUSIONS Screening for retinal angiomas, abdominal masses, and pheochromocytomas as well as genetic analysis is recommended for every patient with a newly diagnosed hemangioblastoma. Follow-up is by magnetic resonance imaging (MRI) of the clinical neuronal region at 6 and at 12-24 months postoperatively. For VHL-associated hemangioblastomas yearly investigation for craniospinal hemangioblastoma by MRI and yearly screening and follow-up for retinal angiomas is recommended. Annual abdominal ultrasound with triennial computed tomography (CT) imaging for abdominal masses is postulated. Annual audiometry is to be performed for possible endolymphatic sac tumor, detailed radiographic imaging of the skull base should be performed upon abnormality in auditory testing. Investigations for cystadenomas of the epidydimis and broad ligament only are mandatory on indication. Annual investigation for pheochromocytoma is recommended.
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Affiliation(s)
- Sven Bamps
- Department of Neurosurgery, University Hospitals Leuven, Herestraat, Belgium
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Current management of Coats disease. Surv Ophthalmol 2013; 59:30-46. [PMID: 24138893 DOI: 10.1016/j.survophthal.2013.03.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 01/11/2023]
Abstract
Since its original description in 1908, Coats disease has been recognized as an idiopathic cause of severe vision loss with a remarkable diversity in clinical presentation and morphology. Key clinical and imaging variables are helpful in differentiating Coats disease from life-threatening malignancies, and proper management revolves around a thorough knowledge of the differential diagnosis. Despite significant advancement in scientific understanding of the disease process and clinical spectrum, the underlying etiology remains obscure, and both primary and secondary forms are recognized. With the development of anti-VEGF therapy, vitreoretinal specialists have a new, effective adjunct to the clinical management of exudates, macular edema, and serous retinal detachment. We highlight the history, diagnostic challenges, evolving clinical spectrum, and current management of Coats disease.
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Jakobiec FA, Grossniklaus HE. Reply: To PMID 23219067. Am J Ophthalmol 2013; 156:203. [PMID: 23791373 DOI: 10.1016/j.ajo.2013.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 03/11/2013] [Indexed: 11/16/2022]
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Park S, Chan CC. Von Hippel-Lindau disease (VHL): a need for a murine model with retinal hemangioblastoma. Histol Histopathol 2012; 27:975-84. [PMID: 22763871 PMCID: PMC3407271 DOI: 10.14670/hh-27.975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Von Hippel-Lindau (VHL) disease is a highly penetrant autosomal dominant systemic malignancy that gives rise to cystic and highly vascularized tumors in a constellation of organs. Patients with VHL disease commonly present with hemangioblastomas in the central nervous system and the eye while other manifestations include pheochromocytoma, clear cell renal cell carcinoma, endolymphatic sac tumors of the middle ear, pancreatic cystadenomas, epididymal and broad ligament cystadenomas. Animal models inactivating the VHL gene product in various organ tissues have been constructed over the past 15 years to parse its HIF-associated mechanisms and its link to tumorigenesis. These models, despite advancing our understanding the molecular role of VHL, are by and large unable to recapitulate the more common features of human VHL disease. Up to date, no model exists that develop retinal hemangioblastomas, the most common clinical manifestation. The purpose of this review is: (1) to discuss the need for an ocular VHL model, (2) to review the animal models that recapitulate clinical VHL disease and (3) to propose potential mechanisms of tumorigenesis for the development of ocular VHL.
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Affiliation(s)
- Stanley Park
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
- Howard Hughes Medical Institute, Chevy Chase, Maryland, USA
| | - Chi-Chao Chan
- Immunopathology Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
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Mennel S, Meyer CH, Callizo J. Combined intravitreal anti-vascular endothelial growth factor (Avastin) and photodynamic therapy to treat retinal juxtapapillary capillary haemangioma. Acta Ophthalmol 2010; 88:610-3. [PMID: 19222401 DOI: 10.1111/j.1755-3768.2008.01449.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Retinal capillary haemangioma complications are characterized by progressive exudation with consecutive intraretinal and subretinal leakage. A successful therapy without side-effects has not been found. We report a case of retinal juxtapapillary capillary haemangioma causing consecutive leakage with macular involvement. The tumour was treated with a combination of anti-vascular endothelial growth factor (VEGF) and photodynamic therapy (PDT) and was followed for 1 year. METHODS A 44-year-old woman with retinal juxtapapillary capillary haemangioma in the right eye experienced a decrease of visual acuity from 20/20 to 20/60 because of a severe leakage from the tumour involving the macula with lipid depositions. Two sessions of PDT (sparing the part of the haemangioma located within the optic disc) and five injections of bevacizumab were applied in a period of 5 months. Visual acuity, visual field testing, retinal thickness measurements, fundus photography and fluorescein angiography were performed to evaluate the treatment effect. RESULTS One year after the last injection, visual acuity increased to 20/40. All lipid exudates at the posterior pole resolved. Retinal thickness decreased from 490 to 150 microm with the restoration of normal central macular architecture. Leakage in fluorescence angiography reduced significantly, but hyperfluorescence of the tumour was still evident. Visual field testing and angiography did not show any treatment-related vaso-occlusive side-effects. CONCLUSION In this single case, the combination of anti-VEGF and PDT appeared to be an effective strategy for the treatment of retinal juxtapapillary capillary haemangioma without side-effects. Further studies with a greater number of eyes and adequate follow-up are necessary to support these first clinical results.
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Affiliation(s)
- Stefan Mennel
- Department of Ophthalmology, Philipps-University Marburg, Germany.
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Abstract
von Hippel-Lindau disease (VHL) disease increases susceptibility to several malignancies, including renal cell carcinoma, haemangioblastomas of the central nervous system or retina and phaeochromocytomas. The VHL tumour suppressor gene, responsible for the disease, encodes for a major regulator of the hypoxic response by targeting the transcription factor hypoxia inducible factor (HIF) for degradation. In this review, we present a synopsis of clinical features of the disease and emphasise unique aspects of VHL syndrome in the paediatric population. Genotype-phenotype associations based on the risk of phaeochromocytoma have pointed to the existence of additional, HIF-independent functions of VHL that remain underexplored. We also examine the progress on these pleiotropic roles of VHL, which contribute to explain clinical features of VHL disease. These advances have important translational implications and are likely to offer a new host of therapeutic options to individuals affected by the disease in the future.
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Affiliation(s)
- Marta Barontini
- Center for Endocrinological Investigations (CEDIE), Hospital de Ninos R. Gutierrez, Buenos Aires, Argentina.
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Abstract
PURPOSE To review recent advances in the diagnosis and treatment of congenital vascular malformations of the retina and choroid. METHODS Review of the current literature on retinal haemangioblastoma, racemose haemangiomatosis, retinal cavernous haemangioblastoma, circumscribed choroidal haemangioma, and diffuse choroidal haemangioma. CONCLUSION The management of patients with congenital vascular lesions of the retina and choroid is advancing rapidly through recent developments in genetic testing, ocular imaging, and treatment. Most are associated with systemic disease, which may be life-threatening. New therapeutic methods such as Verteporfin photodynamic therapy and anti-angiogenic therapy have significantly improved the treatment of retinal and choroidal angiomas and vascular malformations. Ophthalmologists have a major role in detecting and diagnosing these tumours and in providing long-term care in collaboration with a specialist in the field.
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Wu YM, Wong HF, Ng SH. Direct Intratumoral Pre-surgical Embolization of Orbital Hemangioblastoma. A Case Report. Neuroradiol J 2008; 21:693-7. [PMID: 24257013 DOI: 10.1177/197140090802100514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2008] [Accepted: 08/13/2008] [Indexed: 11/16/2022] Open
Abstract
Orbital hemangioblastomas of extraretinal origin are extremely rare and few cases have been reported. We describe a 48-year-old woman with progressive right visual loss and proptosis. Computed tomography showed an avidly enhanced transpatial solid mass in the right orbit with outward protrusion. The mass was presumed to be of extraretinal origin because of its unusually large size, but there was only mild involvement of the eyeball. The histopathologic characteristics of this tumor were identical to those seen in central nervous system hemangioblastomas. The hypervascularity of the lesion would have made surgical intervention difficult. Preoperative embolization was indicated and was performed by direct tumor puncture and injection of N-butyl cyanoacrylate with a satisfactory result.
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Affiliation(s)
- Y-M Wu
- Neuroradiology Department, Chang Gung Memorial Hospital; Taoyuan, Taiwan -
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Surgical Management of Retinal Capillary Hemangioblastoma Associated With Retinal Detachment. Retina 2008; 28:1159-62. [DOI: 10.1097/iae.0b013e31817f2f00] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suh SC, Jin SY, Bae SH, Kim CG, Kim JW. Retinal capillary hemangioma treated with verteporfin photodynamic therapy and intravitreal triamcinolone acetonide. KOREAN JOURNAL OF OPHTHALMOLOGY 2007; 21:178-84. [PMID: 17804927 PMCID: PMC2629681 DOI: 10.3341/kjo.2007.21.3.178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case of retinal capillary hemangioma treated with verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide. Methods A 15-year-old female presented with metamorphopsia in the left eye for 7 days. Examination showed peripheral endophytic retinal capillary hemangioma, macular edema, and a best-corrected visual acuity of 20/50. The hemangioma and macular edema were treated with verteporfin photodynamic therapy and intravitreal triamcinolone acetonide. Results After 5 months of follow-up, involution of the hemangioma, reduction of macular edema, decrease of the feeder and draining vessel diameter, and improvement of best-corrected visual acuity to 20/25 was seen. Conclusions This verteporfin photodynamic therapy combined with intravitreal triamcinolone acetonide appeared to cause involution of the hemangioma with reduction in macular edema and improvement in visual acuity.
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Affiliation(s)
- Shin Cho Suh
- Department of Ophthalmology, College of Medicine, Konyang University, and Konyang University Hospital, Myung Gok Eye Research Institute, Daejeon, Korea
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Wong WT, Agrón E, Coleman HR, Tran T, Reed GF, Csaky K, Chew EY. Clinical characterization of retinal capillary hemangioblastomas in a large population of patients with von Hippel-Lindau disease. Ophthalmology 2007; 115:181-8. [PMID: 17543389 PMCID: PMC3026779 DOI: 10.1016/j.ophtha.2007.03.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Revised: 02/28/2007] [Accepted: 03/01/2007] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To report the epidemiology and ocular phenotype of retinal capillary hemangioblastomas associated with von Hippel-Lindau (VHL) disease in a large cohort of patients and to correlate patient and ocular characteristics to visual morbidity in this population. DESIGN Cross-sectional study. PARTICIPANTS In 220 unrelated pedigrees, 335 patients affected with VHL disease and retinal capillary hemangioblastomas (RCHs) in at least 1 eye. METHODS Demographics of the patient population were recorded and the ocular phenotype of each patient was obtained with a comprehensive ocular examination. MAIN OUTCOME MEASURES The patient population was characterized and the ocular phenotype described in relationship to tumor location, number, and extent of retinal involvement. Correlations between patient demographics, ocular phenotype, and visual function were analyzed. RESULTS We detected RCHs unilaterally in 42.1% and bilaterally in 57.9% of patients. No correlation was detected between the age, gender, or laterality of involvement. Of involved eyes, 86.6% had tumors that could be individually visualized; of these, tumors were commonly found in the peripheral retina (84.7%) only, and less commonly in the juxtapapillary area (15.3%). The tumor count in the periphery averaged 2.5+/-1.8 per eye, with 25.2% of eyes having >1 quadrant of retinal involvement. Of involved eyes, 13.4% were enucleated or prephthsical; approximately 1 in 5 patients had > or =1 eyes so affected. Severe visual impairment (visual acuity < or =20/160) in affected eyes were more likely to be associated with increasing age, the presence of juxtapapillary lesions, and an increasing number and extent of peripheral lesions. CONCLUSIONS This large cohort of VHL patients with RCHs has enabled a systematic and quantitative characterization of the demographics, ocular features, and visual function in VHL disease. Clinical correlations between the visual morbidity and ocular features of the disease were also performed, producing measures that can help clinicians to estimate visual prognoses better based on the ocular phenotype of the disease.
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Affiliation(s)
- Wai T Wong
- Division of Epidemiology and Clinical Research, National Eye Institute, National Institutes of Health, Bethesda, Maryland 20892-1204, USA
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Shechtman D, Vollmer L, Sowka J. Ocular vascular hamartomas: the relationship with phakomatoses and possible commonalities in pathogenesis. OPTOMETRY (ST. LOUIS, MO.) 2006; 77:609-21. [PMID: 17157242 DOI: 10.1016/j.optm.2006.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 05/10/2006] [Accepted: 06/30/2006] [Indexed: 05/12/2023]
Abstract
BACKGROUND Ocular vascular hamartomas may present as isolated lesions or as part of a multisystemic congenital syndrome known as vascular phakomatoses. These syndromes are characterized by ocular, cerebral, and cutaneous lesions. Although each of these lesions manifests distinct characteristics, there may be overlapping characteristics and manifestations attributable to a common pathogenesis. METHODS A case series and a literature review are presented illustrating ocular and systemic manifestations associated with vascular hamartomas, with each case representing varying degrees of ocular and systemic expression. CONCLUSION Because of the potential ocular morbidity and systemic mortality associated with vascular hamartomas and associated syndromes, the optometrist plays an important role in the management of these patients. In general, understanding the pathogenesis of these diseases may contribute to future treatment and prevention opportunities.
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Affiliation(s)
- Diana Shechtman
- Health Professions Division, College of Optometry, Nova Southeastern University College of Optometry, 3200 South University Drive, Ft. Lauderdale, FL 33328, USA.
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Hinz BJ, Schachat AP. Capillary Hemangioma of the Retina and von Hippel–Lindau Disease. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50030-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Moskowitz C, Edelstein C, Oh M, Burnier MN. Retinal capillary hemangioma in von Hippel-Lindau disease. Can J Ophthalmol 2005; 40:192-4. [PMID: 16049535 DOI: 10.1016/s0008-4182(05)80033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Craig Moskowitz
- Department of Ophthalmology, Royal Victoria Hospital and McGill University Health Centre, Montreal, Que
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Abstract
von Hippel-Lindau (VHL) disease is a multisystem inherited cancer syndrome with characteristic tumors and a known genetic basis. Patients with VHL develop, among other tumors, retinal capillary hemangiomas, central nervous system hemangioblastomas, renal clear cell carcinomas, and pheochromocytomas. Nearly all patients can be shown to have a mutation in the VHL gene, which is located on chromosome 3p25. Genetic abnormalities result in abnormal levels of pVHL, which in turn lead to the different tumors. Four distinct phenotypes of VHL disease have been identified based on the relative frequency of and propensity for the development of different VHL tumors. Aggressive screening of patients with VHL disease can prevent morbidity and mortality from these tumors. Although these tumors typically have been treated with observation or surgery, trials of newer medical therapies that target some of the cellular dysregulation caused by mutation in pVHL are ongoing. Even though these trials have not been wholly successful, they present an exciting direction for future research. This article presents a summary of new developments in VHL disease with a focus on ophthalmic and neuro-ophthalmic practice.
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Affiliation(s)
- Eric W Fitz
- Department of Ophthalmology, University of Virginia, Box 800715, Charlottesville, VA 22908, USA.
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Kundi IU, Woon WH. Extrafoveal seafan neovascularization associated with unilateral Recurrent retinal capillary haemangiomas: a known association or a mere coincidence. Eye (Lond) 2004; 18:748-50. [PMID: 14739925 DOI: 10.1038/sj.eye.6700739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Shechtman D, Kabat AG. Retinal capillary angioma managed with trans-pupillary thermotherapy. Clin Exp Optom 2003; 86:253-9. [PMID: 12859246 DOI: 10.1111/j.1444-0938.2003.tb03115.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2002] [Revised: 03/05/2003] [Accepted: 03/12/2003] [Indexed: 11/29/2022] Open
Abstract
Retinal capillary angioma is a tumour-like nodule of the retina and was first described in 1904 by von Hippel. This disease is characterised among the congenital syndromes known as the phakomatoses. It is the only known phakomatosis that does not exhibit skin lesions. A patient with retinal capillary angioma with leakage and haemorrhage is described and the differential diagnosis discussed. In addition, this patient was treated with trans-pupillary thermotherapy and the available therapies are summarised.
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Affiliation(s)
- Diana Shechtman
- Nova Southeastern University, Health Professions Division, College of Optometry, 3200 South University Drive, Fort Lauderdale, Florida 33328, USA
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