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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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Yin Y, Liu S, Liu H, Wu W. Nintedanib inhibits normal human vitreous-induced epithelial-mesenchymal transition in human retinal pigment epithelial cells. Biomed Pharmacother 2023; 166:115403. [PMID: 37659204 DOI: 10.1016/j.biopha.2023.115403] [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: 06/20/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
PURPOSE In this study, we aim to investigate the potential of nintedanib as a therapeutic approach to proliferative vitreoretinopathy (PVR), which is the leading cause of failure in retinal detachment repair. PVR is characterized by the epithelial-mesenchymal transition (EMT) of retinal pigment epithelial (RPE) cells, and understanding the effects of nintedanib on EMT in the normal human vitreous (HV)-induced RPE cells is crucial. METHODS Our research focuses on assessing the impact of nintedanib on HV-induced EMT in human retinal pigment epithelial (ARPE-19) cells in vitro. We employed various techniques, including quantitative real-time PCR (qPCR), western blot analysis, and immunofluorescence staining, to evaluate the mRNA and protein expression of EMT biomarkers in HV-induced ARPE-19 cells. Additionally, we measured the proliferation of RPE cells using cell counting, CCK-8, and Ki-67 assays. Migration was assessed through wound healing and transwell migration assays, while contraction was determined using a collagen gel contraction assay. Morphological changes were examined using phase-contrast microscopy. RESULTS Our results demonstrate that nintedanib selectively attenuates the upregulation of mesenchymal markers in HV-induced ARPE-19 cells, at both the mRNA and protein levels. Furthermore, nintedanib effectively suppresses the HV-induced proliferation, migration, and contraction of ARPE-19 cells, while maintaining the cells' basal activity. These findings strongly suggest that nintedanib exhibits protective effects against EMT in ARPE-19 cells and could be a promising therapeutic option for PVR. CONCLUSIONS By elucidating the anti-EMT effects of nintedanib in HV-induced RPE cells, our study highlights the potential of this oral triple tyrosine kinase inhibitor in the treatment of PVR. These findings contribute to the growing body of research aimed at developing novel strategies to prevent and manage PVR, ultimately improving the success rates of retinal detachment repair.
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Affiliation(s)
- Yiwei Yin
- Department of Ophthalmology, Hunan Key Laboratory of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China; Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shikun Liu
- Department of Pharmacy, Third Xiangya Hospital, Central South University, Changsha, China
| | - Hanhan Liu
- Department of Ophthalmology, Third Xiangya Hospital, Central South University, Changsha, China.
| | - Wenyi Wu
- Department of Ophthalmology, Hunan Key Laboratory of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
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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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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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Reitblat O, Barayev E, Gal-Or O, Tsessler M, Dotan A. Intravitreal Tissue Plasminogen Activator Injection for the Treatment of Proliferative Vitreoretinopathy in a Rabbit Model. Ophthalmic Res 2022; 66:48-56. [PMID: 35772382 DOI: 10.1159/000525745] [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: 06/07/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate the effect of intravitreal injection of tissue plasminogen activator (tPA) on proliferative vitreoretinopathy (PVR). METHODS PVR was induced in a rabbit model by intraocular injection of dispase (0.05 U/0.1 mL). Progression of PVR was followed by indirect ophthalmic examination. Following 6 weeks, 5 animals received intravitreal injection of 25 µg/0.1 mL tPA and four were injected with balanced salt solution (BSS). Animals were euthanized at 48 h following tPA/BSS injection, and eyes were enucleated for histological evaluation and staining with α-smooth muscle actin (αSMA) and Sirius Red. RESULTS Following tPA injection, one eye had a reduction in PVR from grade 2 to 1 and three eyes remained stable. Following BSS, PVR grade was unchanged in three eyes. In one eye in each group, the severity of PVR could not be assessed due to limited view. Staining with αSMA showed reduced presence of fibroblasts in eyes injected with tPA compared with those injected with BSS. Collagen type I and III, demonstrated by Sirius Red staining, was reduced in the tPA group in comparison with controls. CONCLUSION Our results suggest that intravitreally injected tPA may show an inhibitory effect on PVR progression. Further exploration in clinical trials is desired.
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Affiliation(s)
- Olga Reitblat
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edward Barayev
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Gal-Or
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Tsessler
- Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Assaf Dotan
- Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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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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Biewald E, Schlüter S, Kiefer T, Dalbah S, Bornfeld N, Bechrakis NE. [Tumors and Pseudotumors of the Retina and the Ciliary Epithelium]. Klin Monbl Augenheilkd 2020; 237:1359-1378. [PMID: 32777829 DOI: 10.1055/a-1229-0946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The variety of retinal tumors ranges from harmless lesions to benign, locally destructive tumors and life-threatening diseases, and they are not always easy to distinguish from each other. The differential diagnosis includes real neoplasia, reactive inflammatory pathologies and vascular anomalies of the fundus as well. If possible, the diagnosis should be made clinically in order to avoid the danger of tumor cell spread via invasive diagnostic tools. Nevertheless, genetic analysis of the pathology is gaining more importance and adds to the precise characterization of the diagnosis. Depending on the tumor entity, therapy in a specialized center is necessary.
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Biewald E, Schlüter S, Kiefer T, Dalbah S, Bornfeld N, Bechrakis NE. Tumoren und Pseudotumoren der Netzhaut und des Ziliarepithels. AUGENHEILKUNDE UP2DATE 2020. [DOI: 10.1055/a-1128-8784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungDie Varietät retinaler Tumoren reicht von harmlosen Läsionen über benigne, lokal destruierende Tumoren bis hin zu lebensbedrohlichen Erkrankungen. Nicht immer lassen sie sich einfach voneinander unterscheiden. Die Diagnose sollte nach Möglichkeit klinisch gestellt werden wegen der Gefahr einer Tumorzellverschleppung durch invasive Diagnostik. Jedoch rückt die genetische Charakterisierung der Läsion immer mehr in den Vordergrund. Je nach Entität ist eine Therapie in einem spezialisierten Zentrum notwendig.
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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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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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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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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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14
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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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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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Reactive retinal astrocytic tumors (so-called vasoproliferative tumors): histopathologic, immunohistochemical, and genetic studies of four cases. Am J Ophthalmol 2013; 155:593-608.e1. [PMID: 23219067 DOI: 10.1016/j.ajo.2012.09.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the cellular nature of and diagnostic terminology used in connection with acquired retinal "vasoproliferative tumors." DESIGN Retrospective clinicopathologic study. METHODS Clinical records and microscopic slides of 4 enucleated globes were reviewed. Special stains and immunohistochemical probes for CD31, CD34, p53, glial fibrillary acidic protein (GFAP), CD163, and Ki67 (cell replication) were employed; ultrastructural and fluorescence in situ hybridization (FISH) analyses were performed. RESULTS Tumors were located inferotemporally in middle-aged patients. They were uniformly composed of compacted elongated, GFAP-positive spindle cells (due to intermediate filaments identified ultrastructurally) with a Ki67 index of less than 1%. Rosenthal fibers and eosinophilic granular bodies were observed. Hyalinized periodic acid-Schiff-positive vessels were widely separated. CD31 and CD34 revealed a sparse microvasculature. Tumor-associated exudate spread predominantly subretinally. The retinal pigment epithelium had undergone extensive placoid fibrous metaplasia with focal ossification. P53 upregulation, BRAF-KIAA gene rearrangement, and IDH1R132H mutation typically associated with low-grade astrocytic neoplasms were absent. CONCLUSIONS Retinal "vasoproliferative" tumors have been mischaracterized, because they actually display a paucity of microvessels. Proliferating fibrous astrocytes with a very low proliferation index predominate, without immunohistochemical or genetic evidence favoring a neoplasm. Subretinal exudate appeared capable of provoking widespread fibrous metaplasia of the pigment epithelium that was mainly responsible for secondary retinal damage. The term "reactive retinal astrocytic tumor" is proposed as more appropriate for this entity. In carefully selected progressive lesions, consideration should be given to earlier surgical intervention before extensive subretinal exudate accumulates and pigment epithelial proliferation with fibrous metaplasia ensues.
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Heimann H, Jmor F, Damato B. Imaging of retinal and choroidal vascular tumours. Eye (Lond) 2012. [PMID: 23196648 DOI: 10.1038/eye.2012.251] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The most common intraocular vascular tumours are choroidal haemangiomas, vasoproliferative tumours, and retinal haemangioblastomas. Rarer conditions include cavernous retinal angioma and arteriovenous malformations. Options for ablating the tumour include photodynamic therapy, argon laser photocoagulation, trans-scleral diathermy, cryotherapy, anti-angiogenic agents, plaque radiotherapy, and proton beam radiotherapy. Secondary effects are common and include retinal exudates, macular oedema, epiretinal membranes, retinal fibrosis, as well as serous and tractional retinal detachment, which are treated using standard methods (ie, intravitreal anti-angiogenic agents or steroids as well as vitreoretinal procedures, such as epiretinal membrane peeling and release of retinal traction). The detection, diagnosis, and monitoring of vascular tumours and their complications have improved considerably thanks to advances in imaging. These include spectral domain and enhanced depth imaging optical coherence tomography (SD-OCT and EDI-OCT, respectively), wide-angle photography and angiography as well as wide-angle fundus autofluorescence. Such novel imaging has provided new diagnostic clues and has profoundly influenced therapeutic strategies so that vascular tumours and secondary effects are now treated concurrently instead of sequentially, enhancing any opportunities for conserving vision and the eye. In this review, we describe how SD-OCT, EDI-OCT, autofluorescence, wide-angle photography and wide-angle angiography have facilitated the evaluation of eyes with the more common vascular tumours, that is, choroidal haemangioma, retinal vasoproliferative tumours, and retinal haemangioblastoma.
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Affiliation(s)
- H Heimann
- Ocular Oncology Unit, Royal Liverpool University Hospital, Liverpool, UK.
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Bajorat S, Koinzer S, Bräsen JH, Hugo HH, Roider J. [Histological findings in bilateral asymmetrical vasoproliferative retinal tumor]. Ophthalmologe 2012; 109:1026-9. [PMID: 22810150 DOI: 10.1007/s00347-012-2627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We present a case of a bilateral vasoproliferative tumor of the retina in a young man. The first symptom was visual impairment due to vitreous hemorrhage. The right eye showed small tumors which were successfully treated by repeated cryocoagulation, photocoagulation and bevazicumab injection. The tumor in the left eye was larger and eventually led to a painful secondary glaucoma. After enucleation, this tumor was examined histologically and immunohistochemically. The clinical and histological differential diagnoses and therapeutic options are discussed.
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Affiliation(s)
- S Bajorat
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 25, 24105 Kiel.
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Retinal vasoproliferative tumors in ocular conditions of childhood. J AAPOS 2012; 16:6-9. [PMID: 22370658 DOI: 10.1016/j.jaapos.2011.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 10/01/2011] [Accepted: 10/17/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Retinal vasoproliferative tumor (RVPT) is a vascular mass with exudative retinopathy and minimally dilated feeder vessels. This type of tumor can occur as a primary or secondary condition. Our purpose was to describe secondary vasoproliferative tumors from ocular conditions in childhood. METHODS The clinical records and fundus photographs of patients with secondary RVPTs were reviewed and a detailed literature search was conducted to identify reported cases of secondary RVPTs. This information was used to compile a list of ocular and nonocular childhood conditions associated with development of RVPTs. RESULTS The ocular conditions related to vasoproliferative tumors in children include intermediate uveitis, retinitis pigmentosa, ocular toxocariasis, Coats disease, neurofibromatosis, retinal toxoplasmosis, retinopathy of prematurity, familial exudative vitreoretinopathy, and other rare conditions. CONCLUSIONS Several pediatric ocular conditions can ultimately lead to retinal vasoproliferative tumor.
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Smith J, Steel D. The Surgical Management of Vasoproliferative Tumours. Ophthalmologica 2011; 226 Suppl 1:42-5. [DOI: 10.1159/000328209] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Vasoproliferative tumours are uncommon retinal lesions that may occur in isolation (primary) or in association with another ocular condition (secondary). They may be unilateral or bilateral and have a predilection for the peripheral inferior temporal quadrant of the retina. Vasoproliferative tumours can be associated with abnormalities of the macular, including epiretinal membrane formation and cystoid macular edema. A number of modalities have been used to treat these tumours including cryotherapy and radiotherapy.
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Affiliation(s)
- I G Rennie
- Academic Unit of Ophthalmology and Orthoptics, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.
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