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Guo S, Hu R, Wang M, Xia L, Yang P. Dynamic Changes of Fundus and Predictors of Visual Prognosis in New-Onset Vogt-Koyanagi-Harada Disease. Ocul Immunol Inflamm 2024:1-9. [PMID: 38916535 DOI: 10.1080/09273948.2024.2369940] [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: 02/21/2024] [Accepted: 06/15/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE To characterize the dynamic changes of fundus in Vogt-Koyanagi-Harada (VKH) disease through enhanced spectral-domain optical coherence tomography (EDI-OCT) and explore the predictors of visual prognosis. METHODS In this retrospective cohort study, a total of 2152 VKH patients referred to our uveitis center from January 2013 to April 2022 were screened; 151 new-onset VKH patients (299 eyes) and 82 healthy controls (164 eyes) were included. The manifestations of fundus at baseline, 1 month, 3 months, and 12 months after treatment were analysed and their relevance to visual prognosis were evaluated. RESULTS After retinal detachment (RD) (97.3%) and optic disc swelling (100%) presented at baseline, retinal reattachment (81.6%) and the granular hyperreflective depositions at the retinal pigment epithelium (RPE) (61.5%) were observed at month 1. The RPE and ellipsoid zone rearrangement accompanying interdigitation zone attenuation (57.9%) was noted finally. Choroidal thickness of patients was higher than that in the controls at baseline and month 1 (both P < 0.001). Best-corrected visual acuity (BCVA) (logarithm of the minimum angle of resolution [logMAR]) (P < 0.001; OR, 4.01), subretinal fibrinoid exudate (P < 0.001; OR, 3.9) and RPE folds (p = 0.001; OR, 2.39) at baseline, and the RD at month 1 (P < 0.001; OR, 3.42) were associated with visual prognosis. CONCLUSIONS New-onset VKH patients after treatment exhibited dynamic changes in the fundus especially the outer retina during a 12-month period. The BCVA, subretinal fibrinoid exudate, and RPE folds at baseline, and RD at month May 1, serve as predictors of visual prognosis.
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Affiliation(s)
- Suo Guo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Rong Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Meiwen Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Lan Xia
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, China
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Case MJ, Lentz C, Duffy EW, Magrath GN, Cooper SL. Large Vasoproliferative Retinal Tumor Refractory to Cryotherapy Treated with Salvage I-125 Plaque Radiotherapy. Adv Radiat Oncol 2022; 7:100972. [PMID: 35665307 PMCID: PMC9160674 DOI: 10.1016/j.adro.2022.100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/12/2022] [Indexed: 10/28/2022] Open
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Vorobichik Berar O, Tzadok M, Zloto O, Moroz I, Hecht I, Musika AA, Shlomovitz O, Fabian ID, Vishnevskia Dai V. Mammalian target of rapamycin inhibitors for the treatment of astrocytic hamartoma in tuberous sclerosis complex (TSC). Graefes Arch Clin Exp Ophthalmol 2022; 260:3061-3068. [PMID: 35230473 DOI: 10.1007/s00417-022-05585-x] [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: 08/14/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE Tuberous sclerosis complex (TSC) is an inherited neurocutaneous disorder. Fifty percent of patients with TSC will develop retinal astrocytic hamartoma (RAH). The mammalian target of rapamycin (mTOR) inhibitors interferes with the pathological mechanisms of TSC. Treatment of RAH with mTOR inhibitors has been described in only a few isolated case reports. The purpose of this study was to assess the effect of mTOR inhibitors on RAH in a small cohort of patients. METHODS The medical records of all consecutive patients with ocular manifestations of TSC that were treated with mTOR inhibitors at the Sheba Medical Center from January 2014 to December 2018 were retrospectively reviewed. Data collection included demographics, medical history, ocular presentation, ocular treatment, and treatment outcome. Tumor size was assessed by a masked observer, before and after treatment. Lesion measurements were made with Heidelberg SD-OCT (HRA + OCT SPECTRALIS), and fundus photos were taken with RetCam3® (Natus, USA) and analyzed by "ImageJ" software. RESULTS Eleven patients with tuberous sclerosis and astrocytic hamartoma were treated with mTOR inhibitors in the study period. Of them, 6 children (11 eyes, 20 tumors) had proper imaging of tumor size before and after treatment. The analysis included these 11 eyes. All six patients had non-ocular manifestations of TSC, including dermatologic (n = 5), neurologic (n = 5), and renal (n = 3) involvement. Ocular involvement included in five eyes (45%) tumors near the optic disc and in four eyes (37%) foveal tumors. The mean follow-up duration was 2.15 ± 1.4 years (range 10 months to 4.5 years). The average tumor base reduction in the treated group was 17.8% ± 15.9. The average maximal thickness at baseline was 414 ± 174 μm (range 152-686 μm). There was a 14% ± 7.1 reduction after treatment. None of the tumors showed evidence of growth at the final follow-up. CONCLUSION The findings of this study suggest that mTOR inhibitors can reduce tumor size and that they can be considered as an optional treatment in certain conditions. This preliminary report is the first to quantitatively assess pre- and posttreatment tumor size, in young patients.
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Affiliation(s)
- Ofri Vorobichik Berar
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Tzadok
- Pediatric Neurology Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofira Zloto
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Moroz
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Ophthalmology, Shamir Medical Center, Tzrifin, Israel
| | - Anne Ampaire Musika
- Department of Ophthalmology, College of Health Science, Makerere University, Kampala, Uganda
| | - Omer Shlomovitz
- Pediatric Neurology Unit, Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido-Didi Fabian
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vicktoria Vishnevskia Dai
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Tong L, Jia Y, Wang J, Li Y, Chen Z, Liu S, Zhang L. Case Report: Exacerbation and Spontaneous Separation of the Epiretinal Membrane Following Laser Photocoagulation of a Vasoproliferative Tumor of the Retina. Front Med (Lausanne) 2022; 9:770689. [PMID: 35280881 PMCID: PMC8914037 DOI: 10.3389/fmed.2022.770689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
The present report concerns a rare vasoproliferative tumor of the retina (VPTR) combined with a severe case of secondary epiretinal membrane (ERM). A 56-year-old male patient was diagnosed with VPTR and secondary ERM of the left eye. The patient underwent two rounds of laser photocoagulation (LP) of the tumor. The exacerbation of the ERM was observed after the first round of LP, while spontaneous separation over the five-month follow-up period was noted after the second round of LP. Thus, LP may represent a viable alternative treatment approach for VPTR combined with severe ERM.
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Affiliation(s)
- Luyao Tong
- Department of Ophthalmology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yujie Jia
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Ophthalmology and Otorhinolaryngology, Shaoxing Shangyu Women and Children Hospital, Shaoxing, China
| | - Junliang Wang
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Ningbo Eye Hospital, Ningbo, China
| | - Yan Li
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Hangzhou Linping Hospital of Integrated Traditional Chinese and Western Medicine, Hangzhou, China
| | - Zhiqing Chen
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
- Shelan Liu
| | - Li Zhang
- Eye Center of Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Li Zhang
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Management of Vasoproliferative Tumors of the Retina with Macular Complications by Pars Plana Vitrectomy Combined with Episcleral Cryotherapy. J Ophthalmol 2021; 2021:6667755. [PMID: 33953967 PMCID: PMC8057872 DOI: 10.1155/2021/6667755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To evaluate the efficacy of pars plana vitrectomy (PPV) combined with episcleral cryotherapy in treating vasoproliferative tumors of the retina (VPTR) with macular complications. Methods In this retrospective noncomparative interventional case-series analysis, we included 11 eyes of ten patients diagnosed with VPTR. All patients underwent comprehensive ophthalmic examinations and were treated with PPV combined with episcleral cryotherapy. Best-corrected visual acuity (BCVA), tumor activity, retinal morphological structure, and postoperative complications were evaluated. Results Macular complications included epimacular membrane (n = 10), macular hole (n = 3), and macular edema (n = 1). Tumors were treated with triple freeze-thaw episcleral cryotherapy during PPV. The mean logarithm of minimal angle of resolution (logMAR) BCVA dropped from 0.62 ± 0.58 to 0.39 ± 0.46. The difference between the mean values of logMAR BCVA before and after treatment was statistically significant (t = 2.48, P=0.033). The tumor activity was controlled effectively in nine cases. Compared with preoperative tumor activity, tumor activity after treatment was significantly lower (P < 0.01). The increase of central retinal thickness and the disruption of retinal layers were associated with macular holes, macular edema, and retinal proliferative membrane. After the treatment, visual acuity improved in 91% of the cases, and 73% had no long-term complications. Conclusion PPV combined with episcleral cryotherapy promoted tumor regression, preserved retinal integrity, and improved visual acuity. Thus, the combination of PPV with episcleral cryotherapy can be considered effective and safe for the management of VPTR with macular complications.
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Bowen RC, Raval V, Soto H, Singh AD. Intraocular Tumors: Angiographic Patterns. Asia Pac J Ophthalmol (Phila) 2020; 9:449-460. [PMID: 32960821 DOI: 10.1097/apo.0000000000000323] [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: 11/25/2022] Open
Abstract
Intraocular tumors are primarily diagnosed clinically. However, ancillary tests such as fluorescein angiogram provides excellent visualization of retinal tumors while indocyanine green angiography reveals intrinsic vascular patterns of choroidal tumors. In this review, we contrast angiographic patterns of a variety of retinal, choroidal, and iris tumors.
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Abolfathzadeh N, Naseripour M, Jaberi R, Azma Z, Alemzadeh SA, Arbab M, Sedaghat A. Ru-106 plaque radiotherapy for vasoproliferative tumors of retina: a 15-year single-center experience. Int Ophthalmol 2020; 40:2095-2102. [PMID: 32361860 DOI: 10.1007/s10792-020-01386-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study evaluates the outcomes of ruthenium-106 (Ru-106) plaque brachytherapy for vasoproliferative tumors (VPTs) of the ocular fundus in a single referral ocular oncology center. METHODS The clinical charts of all patients diagnosed with VPT who underwent plaque radiotherapy from 2002 to 2017 were reviewed. Clinical features, types of treatment, outcomes and complications were evaluated. RESULTS Of 46 patients with VPT diagnosis in our ocular oncology clinic, 25 (54.34%) cases were treated with Ru-106 plaque brachytherapy. Eleven patients (44%) were male, and the mean age at the time of diagnosis was 40.92 ± 13.11 years. The mean follow-up time was 47.56 ± 36.87 months. Inferotemporal quadrant was the most common site of the tumor (64.00%). The mean delivered apex and scleral dose was 101.56 ± 6.51 and 412.26 ± 113.66 Gray (Gy), respectively. Initial tumor length, width and thickness were 10.26 ± 3.42, 8.05 ± 2.83 and 4.27 ± 1.10 mm, respectively. The mean tumor thickness decreased to 2.60 ± 0.63 mm, postoperatively. Complete resolution of subretinal fluid around the tumor was achieved in 81.80% of cases. Visual acuity was more than 20/400 in 64% of patients before treatment and 60% of patients at last follow-up. CONCLUSION Our study showed that Ru-106 plaque radiotherapy is an effective and safe method of treatment in VPTs.
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Affiliation(s)
- Navid Abolfathzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.,Nikookari Eye Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masood Naseripour
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran
| | - Ramin Jaberi
- Cancer Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azma
- Radiation Medicine Department, Shahid Beheshti University, Tehran, Iran
| | - Sayyed Amirpooya Alemzadeh
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran
| | - Mona Arbab
- Radiation Oncology Department, Indiana University, Indiana, USA
| | - Ahad Sedaghat
- Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Sattarkhan-Niayesh Street, Tehran, 14456-13131, Iran.
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