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Objective:To analyze the perfusion characteristics of choroidal metastasis using contrast-enhanced ultrasound, and compare with choroidal hemangioma.Methods:This was a retrospective study.From January 2016 to February 2018 in Beijing Tongren Hospital, a total of 21 eyes from 21 patients who were clinically diagnosed as choroidal metastasis were included as the choroidal metastasis group and 46 eyes from 46 patients who were diagnosed as choroidal hemangioma during the same period were included as the choroidal hemangioma group. All patients underwent contrast-enhanced ultrasound examination, and Sonoliver was used to obtain the data on quantitative parameters of the tumor and the adjacent normal orbital tissues, including maximum of intensity (IMAX), rise time (RT), time to peak (TTP), and mean transit time (mTT). The quantitative parameters between choroidal metastasis and normal orbital tissues were compared. And the quantitative parameters between choroidal metastasis and choroidal hemangioma were compared. The receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance.Results:The IMAX of choroidal metastasis was significantly higher than that of normal orbital tissues, while RT, TTP and mTT were significantly shorter than these of normal orbital tissues (all P<0.01). The IMAX of choroidal metastasis was lower than that of choroidal hemangioma, and RT, TTP and mTT were shorter than choroidal hemangioma (all P<0.01). The ROC curve analysis showed that area under curves of the IMAX, RT, TTP and mTT were 0.775 (95% CI=0.666-0.884), 0.970 (95% CI=0.896-0.996), 0.729 (95% CI=0.607-0.831) and 0.992 (95% CI=0.931-1.000) respectively. The sensitivities were 71.7%, 95.7%, 76.1% and 95.7%, and the specificities were 85.7%, 90.5%, 66.7% and 95.2%, respectively. Conclusions:Contrast-enhanced ultrasound can reflect the differences in perfusion characteristics between choroidal metastasis and choroidal hemangioma. RT and mTT are useful parameters in differential diagnosis between the two types of tumors.
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Purpose: To study optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) features of circumscribed choroidal hemangioma (CCH) following treatment with photodynamic therapy (PDT) and transpupillary thermotherapy (TTT). Methods: A retrospective chart review of consecutive patients treated for CCH over 2 years (May 2016�April 2018). The investigations, in addition to comprehensive eye examination, included color fundus photography, B-scan ultrasonography, OCT, and OCT-A. Results: The study included 16 eyes of 16 patients (9 males and 7 females). The mean age at presentation was 43.5 � 9 years (range 33�62 years). Macula (n = 6) and superior arcade (n = 5) were the common tumor locations. Twelve eyes received multiple treatment sessions: TTT (seven eyes; mean 2.4 sessions) and PDT (five eyes; mean 2 sessions). Four eyes were observed because vision was not threatened. Pretreatment OCT features were Bruch's membrane atrophy (15 eyes), retinal pigment epithelial atrophy (13 eyes), outer retinal abnormalities (12 eyes), and macular subretinal fluid (12 eyes). Pretreatment OCT-A features were complete loss of choriocapillaris (16 eyes), irregularly arranged fine arborizing vessels (11 eyes), and more than 50% signal void hyporeflective areas (12 eyes). Posttreatment OCT-A showed persistence of choriocapillaris loss, flat scar with fibrosis and thinning of choroid in all eyes treated with TTT, and persistence of deeper choroidal vessels and no loss of choriocapillaris in eyes treated with PDT. Conclusion: OCT and OCT-A help understand the structural outcome following PDT and TTT in circumscribed choroidal hemangioma.
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Circumscribed choroidal hemangioma is a benign vascular tumor which presents in middle-aged adults with progressive diminution of vision, metamorphopsia, floaters, and visual field defects. Diagnosis is based on the characteristic clinical features. It is an orange-red, usually solitary, tumor situated in the posterior pole. The visual symptoms are because of the associated subretinal fluid, cystoid macular edema, and, in long-standing cases, retinal pigment epithelium changes, subretinal fibrosis and retinoschisis. It must be distinguished from the more ominous amelanotic melanoma and choroidal metastasis. Diagnostic tools such as ultrasound, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography are helpful in cases with diagnostic dilemma. Treatment is indicated in symptomatic cases. The management of choroidal hemangioma has evolved over the years beginning with laser photocoagulation to transpupillary thermotherapy, photodynamic therapy, plaque brachytherapy and external beam radiotherapy. No one therapeutic option holds superiority over the other. In this article, we review the epidemiology, clinical manifestations and treatment of the circumscribed variant of choroidal hemangioma.
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Sturge–Weber syndrome (SWS) includes facial, leptomeningeal and choroidal hemangioma. The retinal vasculature is essentially normal. Rare cases of retinal vascular tortuosity and arterio-venous malformations have been reported. We report two cases with rare concomitant retinal vascular abnormalities along with SWS. Both the patients had nevus flammeus, hemifacial hypertrophy, and choroidal hemangioma. In one case, retinal cavernous hemangioma was seen in the affected eye. The other case revealed retinal neovascularization secondary to proliferative diabetic retinopathy in the eye with choroidal hemangioma.
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In this series, we discuss the role of optical coherence tomography angiography (OCTA) in assessing response to treatment in intraocular vascular tumors. This is a series of two cases: Multiple retinal capillary hemangioblastoma (RCH) treated with laser photocoagulation and diffuse choroidal hemangioma (DCH) with radiotherapy. In large RCH and DCH, optical coherence tomography (OCT) showed significant reduction of subretinal and intraretinal fluid. But post-treatment mean tumor vascular density (MTVD) was slightly reduced. In one small RCH, vascular loop was seen suggesting minimal residual disease. So, OCTA helps in identifying treatment inadequacy and understanding alternate mechanism involved in treatment response in vascular tumors.
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Objective To observe the efficacy of photodynamic therapy (PDT) based on indocyanine green angiography (ICGA) for circumscribed choroidal hemangioma (CCH).Methods A retrospective observational case series study was performed.Seventeen eyes of 17 patients were diagnosed with CCH and then underwent PDT based on ICGA image in Xuzhou Municipal Hospital from August,2010 to May,2018.The size of the treatment spot was decided according to ICGA images.The period of mean follow-up visit ranged from 6 to 36 months,with an average of (23.3± 1 1.8) months.Best corrected visual acuity (BCVA),sub-retinal fluid (SRF) and central retinal thickness (CRT) based on optical coherence tomography (OCT),the tumor diameter based on ICGA and the tumor thickness based on coloured doppler imaging (CDI) before and after treatment were analyzed.Results Sixteen cases received only one PDT session,one case had ever received PDT and another case had ever received focal laser photocoagulation.The mean BCVA (LogMAR) was 0.99±0.52,1.09±0.50,0.97±0.53,0.81±0.66,0.79±0.69,and the mean CRT was (440.76±281.34),(329.18± 175.02),(274.24± 169.55),(271.53 ± 150.00),(291.06 ± 201.41)μm before PDT,at 1 week,1 month,3 months and the last visit after treatment,with significant differences among the follow-up time (F =6.965,P =0.006;F =8.784,P =0.002).The decimal visual acuity was increased by at least 2 lines in 9 eyes (52.9％),fluctuated within 2 lines in 7 eyes (41.2％),while decreased by at least 2 lines in one eye (5.9％).SRF of all patients was involved in macular area.The absolute absorption of SRF was found in 7 eyes (41.2％) and partial absorption in 8 eyes (47.1％) at 3 months follow-up visit.In the last follow-up visit,the absolute absorption of SRF was found in 12 eyes (70.6％),partial absorption was found in 3 eyes (17.6％) and 2 eyes (11.8％) underwent no change.On FFA and ICGA,the decrease of tumor size was found in 15 patients,while the others underwent no change.All patients underwent less enhanced hyperfluorescent after treatment.The mean tumor height was (3.80± 1.13)mm before PDT and (3.42± 1.14)mm on the last visit,with a significant difference between them (t=4.101,P=0.010).Conclusions PDT with verteporfin for CCH can promote the improvement of visual acuity,the absorption of SRF,the anatomical reposition of the retina and the decrease of tumor size.The majority of patients can get therapeutic effect after one PDT session.
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PURPOSE: To determine the clinical outcome of anti-vascular endothelial growth factor (anti-VEGF) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma (CCH) with serous retinal detachment. METHODS: The medical records of patients having CCH with serous retinal detachment in macula were retrospectively reviewed. CCH and serous retinal detachment were evaluated via fundus photography, optical coherence tomography, indocyanine green angiography, and ultrasonography. RESULTS: A total of 9 eyes were enrolled in this study. The average follow-up period was 19.2 months. The mean visual acuity was 0.51 ± 0.52 (logMAR) and the mean maximum diameter and thickness of the tumor were 6,154.4 ± 2,019.9 µm and 2,224.4 ± 862.1 µm, respectively. Of the 6 eyes receiving anti-VEGF (mean number of injections: 3.16) as the first treatment for serous retinal detachment, 5 had sustained or recurred intraretinal/subretinal fluid (IRF/SRF) and needed additional PDT and transpupillary thermotherapy. In the 3 eyes that received PDT (mean number of treatments: 1.3) as an initial treatment, IRF/SRF was completely resolved. Finally, 8 eyes achieved complete resolution of SRF and IRF; however visual recovery was limited. CONCLUSIONS: PDT, even with a small number of treatments, can alleviate IRF/SRF in CCH, while anti-VEGF did not.
Subject(s)
Humans , Angiography , Choroid , Endothelial Growth Factors , Follow-Up Studies , Hemangioma , Hyperthermia, Induced , Indocyanine Green , Medical Records , Photochemotherapy , Photography , Retinal Detachment , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Ultrasonography , Visual AcuityABSTRACT
Objective To explore the diagnostic value of ultrasonic elastography in choroidal melanoma. Methods A total of 96 cases (97 eyes) of choroidal melanoma were included in present study from June 2016 to June 2017 in Eye Center of Beijing Tongren Hospital, Capital Medical University. The control group consisted of 18 patients with choroidal hemangioma (18 eyes). All eyes were examined by color Doppler ultrasound and ultrasonic elastosonography. The strain ratio of the tumor and surrounding normal tissue was calculated for each case. By comparing the strain ratio between choroidal melanoma and choroidal hemangioma, the diagnostic value of ultrasound elastography in choroidal melanoma was investigated. Results The strain ratios of the two groups were 39.51±15.79 for choroidal melanoma and 13.15±10.40 for choroidal hemangioma. The independent sample t-test was performed between the two sets of data. The difference of the strain ratio between choroidal melanoma and choroidal hemangioma was statistically significant (t=6.802, P<0.001). Conclusions The stiffness of ocular malignant tumor (choroidal melanoma) is significantly higher than that in intraocular benign tumor (choroidal hemangioma). Ultrasonic elastography can be used as an important examination for the diagnosis and differential diagnosis of choroidal melanoma.
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@#AIM:To investigate the effect of photodynamic therapy(PDT)combined with intravitreal injection of ranibizumab on circumscribed choroidal hemangioma(CCH). <p>METHODS:A retrospective study was performed for 6 eyes(6 cases)diagnosed as CCH. Before treatment, OCT examination showed macular cystoid edema and retinal neurepithelium layer detachment in all patients. All patients underwent photodynamic therapy, then intravitreal injection of ranibizumab 0.5mg(0.05mL)were administered at 48h after PDT. The best corrected visual acuity(BCVA), examination of the ocular fundus, fundus photography, fluorescence fundus angiography(FFA), indocyanine green angiography(ICGA), eye B ultrasonic and optical coherence tomography(OCT)were performed respectively at 1, 3 and 6mo after treatment. <p>RESULTS:The patients were followed up for 4 to 10mo, the final vision of follow-up increased than before, it was raised 7 lines. The images of ICGA revealed hypofluorescence or no leakage in focal area. Eye B ultrasonic showed that hemangioma shrunk or faded. The images of ICGA revealed macular region retinal reattached well and edema disappeared completely. Mean flow-up was 6mo postoperative. There had no evidence of recurrence. <p>CONCLUSION:For CCH patients, hemangioma got smaller obviously by PDT. Intravitreal ranibizumab injection promote effusion absorption under the retina. Combining use of the two therapies could improve visual acuity in a short-term.
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Association of choroidal neovascular (CNV) membrane with circumscribed choroidal hemangioma is rare, and the CNV development after photodynamic therapy (PDT) is also rare. Etiopathogenesis of these associations is poorly understood. We noted the development of CNV over choroidal hemangioma after PDT therapy in a young female patient in our hospital. Temporal association of CNV development after PDT treatment points toward the possible side effects of PDT. Repeat injections of antivascular endothelial growth factor (ranibizumab) regressed the CNV resulting in a favorable visual outcome.
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El hemangioma coroideo circunscrito es un tumor vascular hamartomatoso benigno de baja incidencia. Se presenta este caso debido a su evolución lenta y la pobre respuesta a tratamiento con terapia fotodinámica. El paciente, de sexo masculino, 49 años de edad, con disminución de la visión del ojo derecho de ocho meses de evolución y sin otra sintomatología asociada. Las exploraciones complementarias realizadas (retinografia, OCT, Ecografía y Angiografía flurosceínica) evidencian un tumor yuxtapapilar nasal que es diagnosticado como hemangioma circunscrito de coroides. Se decide tratarlo con terapia fotodinámica. En este caso, aunque el resultado en la ganancia visual no es el esperado, en los exámenes complementarios realizados se observa una discreta mejoría. La lenta evolución de este paciente responde, a criterio de los autores, a varios factores como la edad, el deterioro de la visión en el momento del diagnóstico, el número de aplicaciones de tratamiento con la TFD realizadas, el tiempo de evolución del tumor y el tamaño de la lesión(AU)
Circumscribed choroidal hemangioma is a benign hamartomatous vascular tumor of low incidence. This case is presented for its slow natural history and the poor response to treatment with photodynamic therapy. The 49-year-old male patient with right-eye visual reduction of eight month of evolution and without any other associated symptomatology. Complementary explorations carried out (retinography, OCT, sonogram, fluorescein angiography) evinces a juxtapapillary nasal tumor diagnosed as circumscribed choroidal hemangioma. The decision is to treat it with photodynamic therapy. In this case, despite the fact the visual gain outcome is not the desired, the complementary tests performed revealed a fair improvement. According to the authors, the slow evolution of this patient is due to several factors such as age, visual decay at the time of the diagnosis, the TFD number of applications, the tumor´s time of evolution and the lesion seize(AU)
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Humans , Hemangioma/diagnosis , Hemangioma/drug therapy , Nose Neoplasms/diagnosis , Photosensitizing Agents/therapeutic useABSTRACT
AIM: To investigate the application value of contrast -enhanced ultrasound ( CEUS) and analysis software for intra-ocular tumor diagnosis. METHODS:Retrospective analysis for 90 cases (90 eyes) with intra- ocular tumor with CEUS examination, and all cases were confirmed by pathology after surgery or clinical comprehensive diagnosis and follow-up. RESULTS: Choroidal hemangioma, choroidal melanoma, choroidal metastatic carcinoma had obvious different CEUS enhancement pattern, quantitative analysis indexes of those tumors by imaging analysis software were significantly different (PCONCLUSION: The CEUS can provide quantitative analysis for intra - ocular tumor with preferable clinical application value.
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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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Objetivo: reportar tres casos de pacientes con hemangioma de coroides tratados con terapia fotodinámica (TFD) y realizar una revisión de la literatura sobre el tema. Diseño del estudio: estudio retrospectivo intervencionista, tipo serie de casos. Pacientes y metodología: revisión de historias clínicas y de exámenes complementarios de 3 pacientes con diagnóstico de hemangioma de coroides pre y post tratamiento con TFD en la Fundación Oftalmológica Nacional. Resultados: de los 3 casos presentados, dos se presentaron como hemangiomas de coroides circunscritos y uno difuso en un paciente con síndrome de Sturge Weber. En todos los casos se observó mejoría de la agudeza visual, resolución del desprendimiento seroso de retina y regresión del tumor, sin efectos secundarios a la TFD. Conclusiones: el hemangioma coroideo es una patología con una baja incidencia, de evolución variable y difícil de predecir. La terapia fotodinámica es una alternativa no invasiva, de elección para hemangiomas coroideos sintomáticos, ya que no produce daño a las estructuras vecinas y presenta pocos efectos colaterales.
Objective: to report three cases of patients with choroidal hemangioma treated with photodynamic therapy (PDT) and review of the literature. Study design: retrospective interventional study, cases reports. Patients and methods: review of medical records and ancillary tests were performed in 3 patients with choroidal hemangioma pre and post PDT treatment. Results: of the 3 cases reported, two had a circumscribed choroidal hemangioma and one a diffuse hemangioma associated with Sturge Weber syndrome. All cases had improvement in visual acuity, resolution of serous retinal detachment and tumor regression without PDT side eff ects after follow-up. Conclusions: choroidal hemangiomas have a low incidence and an uncertain prognosis. Photodynamic therapy remains as a noninvasive alternative for symptomatic choroidal hemangiomas, without damage to surrounding structures and few side effects.
Subject(s)
Hemangioma/therapy , Diagnostic Techniques, Ophthalmological/statistics & numerical data , Eye Diseases/therapy , Photochemotherapy/statistics & numerical dataABSTRACT
We report 3 cases of circumscribed choroidal hemangioma (CCH) effectively managed with intravitreal bevacizumab. One patient (case 1) who had recurrent CCH (1.6 mm in thickness) with prior laser photocoagulation was treated with intravitreal bevacizumab alone. Two patients (case 2 and 3) who had CCH (2.4 mm and 2.2 mm in thickness, respectively) with recent visual impairment were treated with bevacizumab followed by photodynamic therapy (PDT). Ophthalmic evaluations included visual acuity, ophthalmoscopic examination, fluorescein angiography, ultrasonography, and optical coherence tomography. Patients were followed up for 6-9 months. After therapy, all patients showed improved visual acuity due to complete resorption of subretinal fluid and macular edema. Ultrasonography demonstrated a reduction of the thickness of CCH in case 1 and complete regression of the lesions in case 2 and 3. No patient showed tumor recurrence. Intravitreal bevacizumab, alone or in combination therapy with PDT, may be a useful alternative for the treatment of symptomatic CCH with subretinal fluid.
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Female , Humans , Male , Middle Aged , Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Choroid Neoplasms/diagnosis , Diagnosis, Differential , Follow-Up Studies , Hemangioma/diagnosis , Injections , Ophthalmoscopy , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A , Vitreous BodyABSTRACT
PURPOSE: To report the clinical features and management of circumscribed choroidal hemangioma. METHODS: Seven patients with circumscribed choroidal hemangioma were reviewed retrospectively. One eye having a small tumor without subretinal fluid was observed. Four eyes with large tumors around the posterior pole were treated with laser photocoagulation or/and transpupillary thermotherapy. Stereotactic radiosurgery with a gamma knife was applied in 2 eyes with large tumors on the peripheral retina. RESULTS: In all cases, the retinal detachment showed complete resolution. Tumor thickness was decreased in 2 cases treated with stereotactic radiosurgery. Visual acuity was either improved or unchanged in 6 eyes and decreased in one eye after treatment. CONCLUSIONS: Circumscribed choroidal hemangioma is a rare intraocular tumor. These tumors can be treated with variable modalities based on their size, location, and subretinal fluid. They have a favorable prognosis. Stereotactic radiotherapy is a reasonable treatment alternative for large symptomatic choroidal hemangiomas.
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Humans , Choroid , Hemangioma , Hyperthermia, Induced , Light Coagulation , Prognosis , Radiosurgery , Radiotherapy , Retina , Retinal Detachment , Retrospective Studies , Subretinal Fluid , Visual AcuityABSTRACT
PURPOSE: We described a patient with decreased vision due to circumscribed choroidal hemangioma and the patient was treated with transpupillary thermotherapy. METHODS: A 40-year-old male with circumscribed choroidal hemangioma combined with serous retinal detachment involving macula was managed by 2 sessions of transpupillary thermotherapy with 810 mm infrared diode laser. RESULTS: Improvement of central visual acuity, atrophy of circumscribed choroidal hemangioma and reabsorption of serous retinal detachment were observed without any complication during 6 months follow up period after 2 sessions of transpupillary thermotherapy. CONCLUSIONS: Transpupillary thermotherapy is a safer and alternatively effective treatment in circumscribed choroidal hemangioma with serous retinal detachment rather than ordinary photocoagulation or radiotherapy.
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Adult , Humans , Male , Atrophy , Choroid , Follow-Up Studies , Hemangioma , Hyperthermia, Induced , Lasers, Semiconductor , Light Coagulation , Radiotherapy , Retinal Detachment , Visual AcuityABSTRACT
Objective To evaluate the clinical effect of transpupillary thermotherapy (TTT) on circumscribed choroidal hemangioma (CCH). Methods The clinical data of 12 eyes of 12 patients with CCH treated with TTT were retrospectively analysed. Infrared diode laser Iridex, oculight SLX was used in TTT at 810 nm and power between 220 and 1 000 mW with a beam diameter of 1.2 or 2 0 or 3 0 mm, with 1 to 2 minutes of exposure time. The visual acuity , subretinal fluid , complication ,thickness and hyperfluorescence of CCH were observed pre and postoperatively in the treated eyes. The average period of follow up was 10 months (6 16 months). Results Among the 8 eyes with peripheral retinal detachment in 12 cases of CCH the peripheral subretinal fluid was completely absorbed in 6 eyes, and partially absorbed in 2 eyes after TTT treatment. In 8 patients undergone ultrasonography, the mean value of tumor thickness went down by 21.75 % in 7 eyes. The resultant visual acuity after treatment was improved in 3 eyes, maintained no change in 7 eyes and reduced in 2 eye. The fundus fluorescein angiography in 10 eyes revealed a significant decrease of the leakage in tumor. Postoperative complication of TTT in the 12 eyes included retinal hemorrhage (5 eyes) and retinal fold (1 eye). Conclusion TTT is an effective treatment for CCH.
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Fluorescein angiography (FAG) has been widely used in the diagnostic evaluation of choroidal tumors. Indocyanine green angiography (ICGA), which permits better visualization of choroidal vasculature than FAG, has been recently introduced into clinical practice. FAG and ICGA of 13 patients with choroidal tumors were assessed. These included 4 patients with choroidal nevus,4 with malignant melanoma, 2 with metastatic choroidal tumor,and 3 with choroidal hemangioma. In choroidal nevus, ICGA showed persistent hypofluorescence with clear delineation of the lesion in the late phase. Characteristic fluorescein angiographic feature of choroidal melanoma was hyperfluorescence in the late phase. However, the fluorescence of melanoma varied from hypo-,to hyperfluores- cent in the late phase of the ICGA. In choroidal metastatic tumor, FAG showed the typical pinpoint hyperfluorescence in the early phase and the diffuse leakage with serous detachment in the late phase. ICGA showed the hypofluo- rescence throughout the whole phases. In choroidal hemangioma, FAG and ICGA showed complete dye filling of the hemangioma with more denser hyperfluorescence in the early phase than in the late phase. In all patients, the lesion was better defined on the ICGA than on the FAG. This study suggests that ICGA combined with FAG may be useful in differentiating various choroidal tumors.
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Humans , Angiography , Choroid , Fluorescein Angiography , Fluorescein , Fluorescence , Hemangioma , Indocyanine Green , Melanoma , NevusABSTRACT
Circumscribed choroidal hemangioma is a rare, benign, vascular hamartom located frequently at the posterior pole. This may lead to symptomatic visual loss when serous retinal detachment occurs at macular area. WE treated successfully a case of circumscribed choroidal hemangioma associated with serous retinal detachment with laser photocoagulation. So, we report this case with a review of the literatures.