Vasoproliferative retinal tumors: Clinical presentation and treatment outcome

Abstract

Objective To study the clinical presentation and treatment outcomes of patients with vasoproliferative retinal tumor (VPRT) in India. Methods Retrospective study of 50 eyes in 47 patients. Results Of the 50 eyes, 25 (50%) were primary and 25 (50%) were secondary. Common ocular pathologies related to secondary VPRT included retinal detachment (n = 8, 32%) and Coats disease (n = 7, 28%). Overall, the mean age at presentation was 35 years (range; 3–74 years) and included 30 (64%) males and 17 (36%) females. The lesions were unilateral in 44 (94%) patients. Secondary retinal features included intra/subretinal exudation (n = 41, 82%), vascularity (n = 32, 64%), subretinal fluid (n = 21, 42%), retinal neovascularisation (n = 9, 18%) and vitreous hemorrhage (n = 8, 16%). Thirty-four eyes (68%) underwent cryotherapy, of which 16 eyes (47%) received adjunct intravitreal anti-VEGF (12 eyes) or corticosteroid injection (4 eyes). Primary surgery included vitrectomy with/without encirclage and cryotherapy (n = 12, 24%) and plaque brachytherapy (n = 3, 6%). At last follow-up (mean 9.7 months, range 3–67 months), 42 eyes (84%) had complete tumor regression with no improvement in visual outcomes when comparing presenting and final best corrected visual acuity. Comparing primary versus secondary VPRT, secondary VPRT presented a decade earlier (31 vs 40 years), needed surgical intervention (48% vs 20%), had poor tumor control (72% vs 92%) and worse visual outcomes ( p < 0.05). Conclusion VPRTs commonly present as a unilateral lesions in the adult population with equal prevalence of primary and secondary variants. Compared with primary VPRT, secondary VPRTs require surgical treatment and are associated with poor visual outcome.

Does vitreous haemorrhage and calcification lead to increased risk of enucleation in advanced retinoblastoma?

“…The origin of VH may differ, but signs of retinal detachment, fundus neovascularization and bleeding from the tumour itself may all lead to haemorrhage accumulation (Biswas et al, 2002; Kiri et al, 2022; Kumar & Sinha, 2007) if not absorbed. Vitreous haemorrhage has been reported with intra‐arterial injections and in persistent cases before enucleation is performed (Shields et al, 2011).…”