Vasoproliferative retinal tumours in a Swedish population

Abstract

Acta Ophthalmol. 2011: 89: 91–94 Abstract. Purpose: To describe the clinical appearance and the visual outcome of a cohort of patients with vasoproliferative retinal tumours (VPRTs) that were diagnosed and treated between 2002 and 2007 at the University Hospital of Örebro. Methods: Nine patients with diagnosed VPRTs were included in a retrospective study. The mean age at the time of diagnosis was 50.2 years (range 7–74 years). Follow‐up time ranged between 14 and 83 months (mean 42.6). Nine out of ten eyes received cryotherapy; six eyes were also treated with photocoagulation. One patient was treated with intravitreal injections of ranibizumab (Lucentis®) and another was referred for brachytherapy. Because of persisting macular oedema, one eye was treated with intravitreal injection of triamcinolon. Results: Of the treated eyes, one had anterior uveitis, six had macular oedema at baseline and four had an exudative retinal detachment at the time of diagnosis. Seven eyes underwent vitrectomy because of epiretinal membranes. Visual acuity at diagnosis was 0.21 (mean) (range 0.02–0.6) and at latest check‐up 0.30 (mean) (range light perception (LP)–1.0), with improvement in six eyes and deterioration in two. Two out of four patients with retinal detachment were successfully treated surgically. Conclusion: VPRTs are benign intraretinal changes. Several complications are associated with this condition. All patients in this study had symptom‐giving tumours and six patients (six eyes) already had profound macular oedema at presentation. In these cases, when complications have already developed, the final visual prognosis is poor, thereby making it important to detect these tumours early. The patient who received anti‐vascular endothelial growth factor (VEGF; Lucentis) therapy showed a slow improvement and distinct regression in exudations during the follow‐up time. However, no increase in visual acuity was seen. At latest examination a peripheral exudative retinal detachment was still observed. Whether anti‐VEGF treatment is effective, as either an alternative or complementary therapy, must be established in the future.

Retinal vasoproliferative tumor

“…Primary tumors correspond from 53 to 80% of the cases in the major reported series (7,9,13) . RVPT affects patients of both genders and all ages, but there is a predominance of women after the 5 th decade (7,8,13) .…”

“…A number of different treatment approaches have been described with variable success rates, usually on case reports or small case series (7,9,10) .…”

“…It seems to be the most frequently employed treatment modality for RVPTs (7,9) . As RVPTS are usually located in the periphery, cryothe rapy can be applied in a transconjunctival way, under observation through binocular indirect ophthalmoscopy.…”

“…There are a few reports of antiangiogenic intravitreous injections for RVPTs, like bevacizumab, ranicizumab and triamcinolone (9,12,29) . Although the exact effect of these substances on RVPTs is lacking, it seems reasonable to consider their use in association to or after other destructive modalities (like cryotherapy) when there is visual acuity decrease due to macular edema.…”

“…On the other way, successful treatment of thicker RVPT with multiple sessions of cryotherapy, PDT, photocoagulation or the association of cryotherapy with intravitreous injectons of antiangiogenic for the secondary re tinal changes were reported (7,8,25,29,31) . Such approaches are probably much more commonly employed in the treatment of RVPTs than bra chytherapy worldwide (9,31) . From our personal perspective, treatment decision should be based on specific tumors characteristics, but also on local availability.…”