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Koç İ, Yücel Gençoğlu A, Yücekul B, Deliktaş Ö, Öztürk E, Kiratli H. Management of circumscribed choroidal hemangioma at a tertiary care center. Int Ophthalmol 2024; 44:307. [PMID: 38955894 DOI: 10.1007/s10792-024-03238-y] [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: 09/10/2023] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE To review long-term outcomes of circumscribed choroidal hemangioma (CCH). METHODS Hospital charts of all CCH cases diagnosed from 2008 to 2019 were retrospectively reviewed. RESULTS All 172 patients were managed with either observation, transpupillary thermotherapy, argon laser photocoagulation, photodynamic therapy, plaque brachytherapy or stereotactic radiosurgery. The most common 3 modes of management were clinical observation (30.2%), transpupillary thermotherapy (52.9%) and argon laser photocoagulation (8.7%). Median follow-up time was 10 months (range: 3, 160). Anatomical outcomes were stable in 87.1% of observation group and improved in 60.5% of thermotherapy group. Quantified optical coherence tomography angiography findings showed statistical differences in vascular and perfusion densities in fellow eyes of hemangioma patients. CONCLUSION Circumscribed choroidal hemangioma can be treated in various ways. Transpupillary thermotherapy is an anatomically effective treatment in selected cases. The diagnosis of CCH may have vascular implications in fellow eyes of the patients.
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Affiliation(s)
- İrem Koç
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey.
| | | | - Burcu Yücekul
- Department of Ophthalmology, University of Health Science, İstanbul Haseki Training and Research Hospital, Istanbul, Turkey
| | - Özge Deliktaş
- Department of Ophthalmology, Bursa City Hospital, Bursa, Turkey
| | - Ebru Öztürk
- Department of Biostatistics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hayyam Kiratli
- Ocular Oncology Service, Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
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Si Y, Li Y, Zhao J, Bi X, Shi Q, Shi L, Wang Q, Zhang P. Comparison of the therapeutic effects of photodynamic therapy, transpupillary thermotherapy, and their combination on circumscribed choroidal haemangioma. Photodiagnosis Photodyn Ther 2024; 48:104250. [PMID: 38885852 DOI: 10.1016/j.pdpdt.2024.104250] [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: 03/26/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To characterize the clinical and imaging features of circumscribed choroidal hemangioma (CCH), and to evaluate individualized treatment efficiency of photodynamic therapy (PDT), transpupillary thermotherapy (TTT), or their combination, followed by retrobulbar injection of betamethasone on CCH resolvement. METHODS Forty-nine patients with CCHs who underwent PDT, TTT or PDT+TTT treatments were retrospectively analyzed. Their treatment efficacy was compared by analyzing the change of best corrected visual acuity (BCVA), subretinal fluid (SRF) and CCH lesion characteristics. RESULTS PDT, TTT and PDT+TTT were respectively administrated in 17, 11 and 21 patients. No significant difference in age, gender, affected eyes and tumor location across the three groups. Baseline BCVA were 0.41 ± 0.28, 0.62 ± 0.30 and 0.24 ± 0.24 for PDT, TTT and PDT+TTT groups, respectively (F = 6.572, P = 0.003). CCH treated by three strategies showed significant difference in maximum tumor basal diameter, SRF areas and macula involvement prior to the treatment (P < 0.05). Patients receiving PDT+TTT exhibited larger tumor basal diameter, more SRF, higher ratio of macular involvement than other groups. A total of 38 (77.6 %) cases had good visual acidity with final BCVA ≥0.5 after treatments. PDT and PDT+TTT treatment groups acquired more vision improvement (0.27 ± 0.23 and 0.31 ± 0.26) in BCVA than TTT group (0.09 ± 0.13). All SRF were resolved within two weeks of treatment and no recurrent SRF were found. CONCLUSION The three treatments showed good performance in improving visual function and controlling SRF, and individualized treatment should be selected primarily by the tumor location, and then the tumor size and presence of SRF.
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Affiliation(s)
- Yanfang Si
- Department of Ophthalmology, the Eighth Medical Center, Affiliated to Senion Department of Ophthalmology, the Third Medical center, Chinese PLA General Hospital, Beijing 100091, China.
| | - Ying Li
- Department of Ophthalmology, the First Medical Center, Chinese PLA General Hospital, Beijing 100041, China
| | - Juan Zhao
- Department of Ophthalmology, the Eighth Medical Center, Affiliated to Senion Department of Ophthalmology, the Third Medical center, Chinese PLA General Hospital, Beijing 100091, China
| | - Xiaoda Bi
- Department of Ophthalmology, the Eighth Medical Center, Affiliated to Senion Department of Ophthalmology, the Third Medical center, Chinese PLA General Hospital, Beijing 100091, China
| | - Qian Shi
- Department of Ophthalmology, the Eighth Medical Center, Affiliated to Senion Department of Ophthalmology, the Third Medical center, Chinese PLA General Hospital, Beijing 100091, China
| | - Lei Shi
- Department of General Medicine, Jingnan Medical District, Chinese PLA General Hospital, Beijing 100036, China
| | - Qian Wang
- Department of Ophthalmology, the Eighth Medical Center, Affiliated to Senion Department of Ophthalmology, the Third Medical center, Chinese PLA General Hospital, Beijing 100091, China
| | - Ping Zhang
- Department of Dermatology, People's Liberation Army Air Force Special Medical Center, Beijing 100142, China.
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Lupidi M, Centini C, Castellucci G, Nicolai M, Lassandro N, Cagini C, Rizzo C, Chhablani J, Mariotti C. New insights on circumscribed choroidal hemangioma: "bench to bedside". Graefes Arch Clin Exp Ophthalmol 2024; 262:1093-1110. [PMID: 37505277 PMCID: PMC10995022 DOI: 10.1007/s00417-023-06179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
Circumscribed choroidal hemangioma is a rare vascular hamartoma of the choroid, presenting as a red-orange mass at the posterior pole on fundoscopic examination. Despite its benign origin, associated complications such as subretinal fluid, serous retinal detachment, retinoschisis and neovascular glaucoma may lead to serious visual impairment in more than half patients. Because of its similarity to amelanotic choroidal melanoma and choroidal metastasis, differential diagnosis is still challenging for specialists. Multimodal imaging such as ultrasonography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography guides the clinician to the correct diagnosis and the proper follow-up. Treatment is indicated in symptomatic cases in order to resolve exudation and improve visual acuity. Treatment options include photocoagulation, transpupillary thermotherapy, radiation therapy, photodynamic therapy and anti-vascular endothelial growth factor therapy. Currently, photodynamic therapy is the treatment of choice due to its effectiveness and safety. The purpose of this review is to describe the latest knowledge in the etiopathogenesis of the circumscribed choroidal hemangioma, the most recent multimodal imaging findings, and the available treatment options.
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Affiliation(s)
- Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
- Fondazione Per La Macula Onlus, Dipartimento Di Neuroscienze, Riabilitazione, OftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genoa, Italy.
| | - Chiara Centini
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Greta Castellucci
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Michele Nicolai
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Nicola Lassandro
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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β-Adrenoreceptors as Therapeutic Targets for Ocular Tumors and Other Eye Diseases-Historical Aspects and Nowadays Understanding. Int J Mol Sci 2023; 24:ijms24054698. [PMID: 36902129 PMCID: PMC10003534 DOI: 10.3390/ijms24054698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
β-adrenoreceptors (ARs) are members of the superfamily of G-protein-coupled receptors (GPCRs), and are activated by catecholamines, such as epinephrine and norepinephrine. Three subtypes of β-ARs (β1, β2, and β3) have been identified with different distributions among ocular tissues. Importantly, β-ARs are an established target in the treatment of glaucoma. Moreover, β-adrenergic signaling has been associated with the development and progression of various tumor types. Hence, β-ARs are a potential therapeutic target for ocular neoplasms, such as ocular hemangioma and uveal melanoma. This review aims to discuss the expression and function of individual β-AR subtypes in ocular structures, as well as their role in the treatment of ocular diseases, including ocular tumors.
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Alhayaza R, Khan SA, Semidey VA, Owaidhah O. The Effectiveness of Propranolol in Managing Hemorrhagic Choroidal and Exudative Retinal Detachment following Ahmed Glaucoma Valve Implantation in Sturge-Weber Syndrome: Case Report and Literature Review. Case Rep Ophthalmol 2021; 12:859-869. [PMID: 34899259 PMCID: PMC8613549 DOI: 10.1159/000518805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
Sturge-Weber syndrome (SWS) is a congenital neurological disorder that is characterized by hamartomas involving the skin, brain, and eyes and marked by the presence of the facial port-wine stain, which consequently leads to various ocular complications. Among all ocular comorbidities, glaucoma is the most frequently witnessed in SWS patients with a prevalence of 30%–70%. If glaucoma is refractory to conventional medical management, surgical intervention can be considered. Common complications of glaucoma procedures in SWS are choroidal detachment and suprachoroidal hemorrhage. Moreover, we report a 6-year-old girl, known case of unilateral congenital glaucoma secondary to SWS. Despite being on maximal antiglaucoma drops and undergoing multiple surgical interventions, the patient had uncontrolled intraocular pressure of her right eye. A decision to proceed with Ahmed glaucoma valve implantation (AGVI) to the right eye was made. In the immediate postoperative period, the patient developed hemorrhagic choroidal detachment and exudative retinal detachment. A trial of oral propranolol (1.5–2 mg/kg/day) was then initiated for 4 months. After 30 days from oral propranolol course initiation, we started noticing a significant improvement of the hemorrhagic choroidal and exudative retinal detachment. Spontaneously, a marked reduction in subretinal fluid and suprachoroidal hemorrhage was also seen. Thus, the improvement was correlated with the propranolol therapy. Here, we report a significant improvement of the postoperative complications of AGVI in a patient with SWS, following 4 months of oral propranolol course (1.5–2 mg/kg/day). Further studies are needed to determine the dosage, duration, and optimal mechanism by which propranolol works in this situation.
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Affiliation(s)
- Raid Alhayaza
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Saud A Khan
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Ohoud Owaidhah
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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O'Bryhim BE, Li AS, Bayliss SJ, Tychsen L, Lueder GT, Rajagopal R. Successful treatment of an exudative choroidal hemangioma with oral propranolol in a 10-year-old boy. J AAPOS 2019; 23:236-238. [PMID: 30959167 PMCID: PMC6778008 DOI: 10.1016/j.jaapos.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/22/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
A 10-year-old boy was referred for a circumscribed choroidal hemangioma with underlying exudative detachment of the left eye. To avoid general anesthetics required for laser-based therapy in a child, we began a trial of oral propranolol. The patient's exudative detachment resolved, with resulting improvement in visual acuity, and remained quiescent for 3 years.
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Affiliation(s)
- Bliss E O'Bryhim
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Albert S Li
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Susan J Bayliss
- Department of Dermatology, St. Louis Children's Hospital, St. Louis, Missouri
| | - Lawrence Tychsen
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Gregg T Lueder
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
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8
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Oral Propranolol Therapy for Management of Exudative Retinal Detachment from Diffuse Choroidal Hemangioma in Sturge-Weber Syndrome. Eur J Ophthalmol 2018; 23:922-4. [DOI: 10.5301/ejo.5000322] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/20/2022]
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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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10
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Abstract
Circumscribed choroidal hemangiomas are benign vascular hamartomas without systemic associations. Generally, they are orange-red elevated masses, which are found posterior to the equator. Lesions are usually solitary and unilateral. Overlying subretinal fluid, serous retinal detachment and cystoid macular edema are common findings. Intravenous fluorescein angiography, indocyanine green angiography, ultrasonography, optical coherence tomography and enhanced depth imaging are helpful ancillary tests for diagnosis of circumscribed choroidal hemangiomas. Asymptomatic circumscribed choroidal hemangiomas do not require treatment. For symptomatic lesions with exudative retinal detachment or cystoid macular edema, photodynamic therapy has emerged as the treatment of choice with high rates of tumor regression, subretinal fluid resorption and minimal complications. Lens-sparing external beam radiotherapy, plaque brachytherapy, proton beam therapy, stereotactic radiosurgery, transpupillary thermotherapy, laser photocoagulation and anti-VEGF injections are other treatment modalities.
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Affiliation(s)
- Saeed Karimi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arman Mashayekhi
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Tanabe H, Sahashi K, Kitano T, Tomita Y, Saito AM, Hirose H. Effects of Oral Propranolol on a Juxtapapillary Capillary Hemangioma: A Single-Subject Pilot Study. Ophthalmic Surg Lasers Imaging Retina 2015; 46:380-3. [DOI: 10.3928/23258160-20150323-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 11/10/2014] [Indexed: 11/20/2022]
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Hernández-Martínez P, Gallego-Pinazo R, Dolz-Marco R, Arevalo JF, Díaz-Llopis M, Cisneros Lanuza A. Oral propranolol and intravitreal ranibizumab for refractory serous macular detachment secondary to retinal capillary hemangioblastoma. ACTA ACUST UNITED AC 2014; 90:399-401. [PMID: 25433416 DOI: 10.1016/j.oftal.2014.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 11/17/2022]
Affiliation(s)
- P Hernández-Martínez
- Departamento de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - R Gallego-Pinazo
- Departamento de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - R Dolz-Marco
- Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - J F Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland, Estados Unidos; Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riad, Arabia Saudí
| | - M Díaz-Llopis
- Departamento de Cirugía, Facultad de Medicina, Universidad de Valencia, Valencia, España
| | - A Cisneros Lanuza
- Departamento de Oftalmología, Hospital Universitario y Politécnico La Fe, Valencia, España
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Ollague Sierra JE, Ollague Torres JM. Annular telangiectatic perivascular angiomatosis: a paradoxical adverse event of propranolol. Br J Dermatol 2013; 169:1369-71. [PMID: 23870064 DOI: 10.1111/bjd.12520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J E Ollague Sierra
- Department of Dermatology, University of Miami, 1600 NW 10th Avenue, Miami, FL, 33136, U.S.A.
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