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Poliner A, Fernandez Faith E, Blieden L, Kelly KM, Metry D. Port-wine Birthmarks: Update on Diagnosis, Risk Assessment for Sturge-Weber Syndrome, and Management. Pediatr Rev 2022; 43:507-516. [PMID: 36045161 DOI: 10.1542/pir.2021-005437] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sturge-Weber syndrome (SWS) is a neurocutaneous disorder that classically presents with a triad of vascular anomalies affecting the skin, eyes, and brain. Previously, the trigeminal nerve distribution of a port-wine birthmark (PWB) of the face was used to identify risk of SWS. However, recent evidence has demonstrated that PWBs are vascular, not neurologic, in embryologic origin, and facial PWBs at highest risk for the brain involvement of SWS involve the forehead location. Furthermore, a PWB involving the upper or lower eyelid carries a risk of glaucoma, which requires lifelong monitoring. The gold standard of treatment for PWB is the pulsed dye laser, which has many advantages when started as early as possible in infancy. In this review, we discuss the locations of facial PWBs at risk for neurologic and ophthalmologic complications, the differential diagnosis of facial vascular birthmarks, recommendations for patient referral(s) when needed, and the advantages of early laser therapy when desired for the PWB. We also provide additional resources for pediatricians to support patients and their families.
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Affiliation(s)
| | - Esteban Fernandez Faith
- Division of Dermatology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | | | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, CA
| | - Denise Metry
- Dermatology, Baylor College of Medicine, Houston, TX.,Department of Dermatology, Texas Children's Hospital, Houston, TX
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Hassanpour K, Nourinia R, Gerami E, Mahmoudi G, Esfandiari H. Ocular Manifestations of the Sturge-Weber Syndrome. J Ophthalmic Vis Res 2021; 16:415-431. [PMID: 34394871 PMCID: PMC8358762 DOI: 10.18502/jovr.v16i3.9438] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Sturge-Weber syndrome (SWS) or encephalotrigeminal angiomatosis is a non-inherited congenital disorder characterized by neurologic, skin, and ocular abnormalities. A somatic activating mutation (R183Q) in the GNAQ gene during early embryogenesis has been recently recognized as the etiology of vascular abnormalities in SWS. Approximately, half of the patients with SWS manifest ocular involvement including glaucoma as the most common ocular abnormality followed by choroidal hemangioma (CH). The underlying pathophysiology of glaucoma in SWS has not been completely understood yet. Early onset glaucoma comprising 60% of SWS glaucoma have lower success rates after medical and surgical treatments compared with primary congenital glaucoma. Primary angle surgery is associated with modest success in the early onset SWS glaucoma while the success rate significantly decreases in late onset glaucoma. Filtration surgery is associated with a higher risk of intraoperative and postoperative choroidal effusion and suprachoroidal hemorrhage. CH is reported in 40-50% of SWS patients. The goal of treatment in patients with CH is to induce involution of the hemangioma, with reduction of subretinal and intraretinal fluid and minimal damage to the neurosensory retina. The decision for treating diffuse CHs highly depends on the patient's visual acuity, the need for glaucoma surgery, the presence of subretinal fluid (SRF), its chronicity, and the potential for visual recovery.
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Affiliation(s)
- Kiana Hassanpour
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Ophthalmology, Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ramin Nourinia
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ebrahim Gerami
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghavam Mahmoudi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Esfandiari
- Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Abstract
PURPOSE OF REVIEW Sturge-Weber syndrome (SWS) is a rare, congenital disease which frequently involves the eye. It is important that ophthalmologists recognize this syndrome and are aware of its range of ocular manifestations. The aim of this article is to present our understanding of the pathogenesis and clinical manifestations of this syndrome and provide updated information on the treatment of SWS glaucoma and choroidal hemangioma. RECENT FINDINGS SWS glaucoma usually fails medical management. Surgical options include angle procedures, filtering procedures, device placement, and combination procedures. Combination procedures have become popular in this population due to the single procedure failure rate of angle surgery and the complications associated with device implantation. Choroidal hemangioma is best treated by photodynamic therapy. SUMMARY Lifelong monitoring for ocular complications related to SWS is essential. There is a need for consensus guidelines on care and surveillance of patients with SWS to provide the best care for these patients.
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Kaushik S, Kataria P, Joshi G, Singh R, Handa S, Pandav SS, Ram J, Gupta A. Perioperative Propranolol: A Useful Adjunct for Glaucoma Surgery in Sturge-Weber Syndrome. Ophthalmol Glaucoma 2019; 2:267-274. [PMID: 32672550 DOI: 10.1016/j.ogla.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Ocular manifestations of Sturge-Weber syndrome (SWS) include choroidal hemangioma and glaucoma. Intraocular pressure (IOP) reduction in these patients commonly is associated with sight-threatening choroidal effusions. Oral propranolol is the standard of care for infantile cutaneous hemangioma, but its role in choroidal hemangioma largely is unexplored. We studied the role of perioperative oral propranolol during glaucoma surgery in SWS. DESIGN Prospective, nonrandomized case series with historical controls. PARTICIPANTS Fourteen eyes of 12 patients with SWS scheduled for glaucoma surgery were included, and the outcomes were compared with those of historical controls without propranolol use (15 eyes of 14 patients). METHODS Patients in the prospective cohort received oral propranolol 2 mg/kg of body weight daily in 2 divided doses 1 week before surgery and continued for 6 weeks after surgery. There was no modification (e.g., posterior sclerotomy) in the existing surgical technique. The historical control group was identified from records and SWS diagnosis validated by chart review. MAIN OUTCOME MEASURES The incidence and extent of postoperative choroidal effusion, additional procedures required compared with the control group, and adverse effects of the drug in the prospective cohort. RESULTS Average follow-up was 25.7±12.1 months (95% confidence interval, 19.3-32.1 months). The intraocular pressure reduced from 25.2±9.7 mmHg at presentation to 16.25±6.2 mmHg, 14.6±4.5 mmHg, 13.7±6.4 mmHg, and 16.5±8.0 mmHg at 1 week, 1 month, 3 months, and 1 year after surgery, respectively. In the perioperative propranolol group, no patient demonstrated sight-threatening choroidal effusion within the vascular arcades. In the 2 patients with bilateral disease, both eyes of each patient showed peripheral choroidal effusion, which settled with medical treatment. Surgery was a repeat procedure in 3 of the 4 eyes. There were no adverse effects of propranolol in any patient. In the control group, 5 of 12 eyes showed peripheral choroidal effusion after primary glaucoma surgery, whereas 5 of 6 eyes that underwent repeat surgery failed demonstrated sight-threatening choroidal effusion requiring surgical intervention. CONCLUSIONS Oral propranolol seems to be an effective method to minimize the development of sight-threatening choroidal effusion after glaucoma surgery in SWS.
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Affiliation(s)
- Sushmita Kaushik
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pankaj Kataria
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Gunjan Joshi
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sabia Handa
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Pandav
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amod Gupta
- Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Thavikulwat AT, Edward DP, AlDarrab A, Vajaranant TS. Pathophysiology and management of glaucoma associated with phakomatoses. J Neurosci Res 2018; 97:57-69. [DOI: 10.1002/jnr.24241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/10/2018] [Accepted: 03/12/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Alisa T. Thavikulwat
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
| | - Deepak P. Edward
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
| | - Abdulrahman AlDarrab
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
- Department of Surgery, College of Medicine; Prince Sattam Bin Abdulaziz University; Alkharj Saudi Arabia
| | - Thasarat S. Vajaranant
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
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Javaid U, Ali MH, Jamal S, Butt NH. Pathophysiology, diagnosis, and management of glaucoma associated with Sturge-Weber syndrome. Int Ophthalmol 2017; 38:409-416. [PMID: 28064423 DOI: 10.1007/s10792-016-0412-3] [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] [Received: 05/30/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Sturge-Weber syndrome (SWS), also known as encephalotrigeminal angiomatosis, is a condition which includes leptomeningeal hemangioma, facial angiomatosis or nevus flammeus, and ocular changes. SWS can lead to severe complications of anterior segment involving conjunctiva and eyelids, whereas posterior segment of the eye may also be affected by diffuse choroidal hemorrhages. This article was written with the objectives to determine the pathophysiology, diagnosis, and treatment of glaucoma associated with this rare and challenging disorder. METHODS A detailed literature search was conducted on PubMed, EMBASE, Cochrane Library, and Google Scholar using the key words. Forty-five articles matched our inclusion criteria that were included in this systematic review. RESULTS Glaucoma is the one of the commonest ocular manifestations of SWS. It is caused by anterior chamber malformations, increased pressure in the episcleral veins, and changes in ocular hemodynamics. Glaucoma associated with SWS is usually congenital but can develop adults as well. The treatment of glaucoma associated with SWS is quite challenging because of early-onset, severe visual field impairment at the time of diagnosis, and unresponsiveness to standard medical treatment. Several surgical procedures have been devised but the long-term control of the intraocular pressure and visual function remain unsatisfactory. Modifications in the filtration surgery techniques and use of newer anti-fibrotic agents have produced good control of intraocular pressure. CONCLUSION Management of glaucoma associated with SWS is multi-dimensional and needs both medical and surgical interventions for better control. The treatment should be devised on case to case basis depending upon the intraocular pressure, stage of the disease, and type of glaucoma.
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Affiliation(s)
- Usman Javaid
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Muhammad Hassaan Ali
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan.
| | - Samreen Jamal
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Nadeem Hafeez Butt
- Department of Ophthalmology, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
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Mantelli F, Bruscolini A, La Cava M, Abdolrahimzadeh S, Lambiase A. Ocular manifestations of Sturge-Weber syndrome: pathogenesis, diagnosis, and management. Clin Ophthalmol 2016; 10:871-8. [PMID: 27257371 PMCID: PMC4874637 DOI: 10.2147/opth.s101963] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Sturge–Weber syndrome has been included in the group of phakomatoses that is characterized by hamartomas involving the brain, skin, and eyes. The characteristic facial port-wine stain, involving the first branch of the trigeminal nerve and the embryonic vasculature distribution in this area, leads to several ocular complications of the anterior segment and can involve the eyelids and conjunctiva. The posterior segment of the eyes is also affected with diffuse choroidal hemangiomas. However, the most frequent ocular comorbidity is glaucoma with a prevalence rate ranging from 30%–70%. Glaucoma is related to anterior chamber malformations, high episcleral venous pressure (EVP), and changes in ocular hemodynamics. Glaucoma can be diagnosed at birth, but the disease can also develop during childhood and in adults. The management of glaucoma in Sturge–Weber syndrome patients is particularly challenging because of early onset, frequently associated severe visual field impairment at the time of diagnosis, and unresponsiveness to standard treatment. Several surgical approaches have been proposed, but long-term prognosis for both intraocular pressure control and visual function remains unsatisfactory in these patients. Choroidal hemangiomas may also lead to visual impairment thorough exudative retinal detachment and macular edema. Treatment of exudative hemangioma complications is aimed at destructing the tumor or decreasing tumor leakage.
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Affiliation(s)
- Flavio Mantelli
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, USA
| | - Alice Bruscolini
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Maurizio La Cava
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Solmaz Abdolrahimzadeh
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
| | - Alessandro Lambiase
- Department of Sense Organs, Section of Ophthalmology, University of Rome "Sapienza", Rome, Italy
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