Bilateral diffuse choroidal hemangioma in Sturge Weber syndrome: A case report highlighting the role of multimodal imaging and a brief review of the literature.

PURPOSE: To present a patient with bilateral choroidal hemangioma in Sturge-Weber syndrome (SWS) and highlight multimodal imaging techniques for early detection and management of ocular alterations. METHODS: A 37-year-old woman with diagnosis of SWS presented to our unit. The patient had been treated with pulsed dye laser for bilateral nevus flammeus and had right leptomeningeal angiomatosis. She had glaucoma, but ultrasound biomicroscopy did not show anterior chamber or ciliary body alterations. RESULTS: Enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT) showed bilateral diffuse choroidal hemangiomas in both eyes with choroidal thickness above 1000 µm. B-scan ultrasound examination showed diffuse choroidal hemangioma in both eyes, with a choroidal thickness of 1.53 mm and 1.94 mm in the right and left eye (RE, LE), respectively. Peripapillary retinal nerve fiber evaluation showed thinning of the retinal nerve fiber layer in both eyes. CONCLUSIONS: This report highlights multimodal imaging techniques for the critical assessment of patients with SWS, especially in rare cases with bilateral choroidal hemangioma of the choroid. Novel imaging modalities enable optimal management and follow-up of rare conditions, and our case adds further evidence to the existing literature.

Nd: Yag laser iridotomy in Shaffer-Etienne grade 1 and 2: angle widening in our case studies.

AIM: To obtain widening of a potentially occludable angle, in according to Kanski's indications, through preventive Nd:Yag laser iridotomy. The observational study was performed by using gonioscopy for the selection and follow-up of 1165 treated eyes and exploiting Shaffer-Etienne gonioscopic classification as a quality/quantity test of the angle recession. METHODS: Between September 2000 and July 2012, 586 patients were selected at the Outpatients' Ophthalmological Clinic of the Policlinico Umberto I of Rome in order to undergo Nd: Yag laser iridotomy. A Goldmann type contact lens, Q-switched mode, 2-3 defocus, and 7-9 mJ intensity with 2-3 impulse discharges were used for surgery. RESULTS: From as early as the first week, a whole 360° angle widening were evident in the patients, thus showing the success of Nd:Yag laser iridotomy in solving relative pupil block. The angle remained narrow by 270° in 14 eyes only, despite repetitions of further treatment with laser iridotomy in a different part of the iris, twice in 10 eyes and three times in 4 eyes. CONCLUSION: Nd:Yag laser iridotomy revealed itself as being a safe and effective treatment in widening those critical Shaffer-Etienne grade 1 and 2 potentially occludable angles.