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PHOTO ESSAY
Year : 2021  |  Volume : 1  |  Issue : 1  |  Page : 67-68

Single sitting multi-spot photodynamic therapy in management of large optic nerve head hemangioblastoma with macular edema


Centre for Sight, Department of Vitreoretina, New Delhi, India

Date of Submission09-Apr-2020
Date of Acceptance17-Jul-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Ritesh Narula
B-5/24 Safdarjung Enclave, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_900_20

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  Abstract 


Keywords: Hemangioblastoma, optic nerve head, photodynamic therapy


How to cite this article:
Gupta A, Narula R, Talwar D, Verma L, Pawar SR. Single sitting multi-spot photodynamic therapy in management of large optic nerve head hemangioblastoma with macular edema. Indian J Ophthalmol Case Rep 2021;1:67-8

How to cite this URL:
Gupta A, Narula R, Talwar D, Verma L, Pawar SR. Single sitting multi-spot photodynamic therapy in management of large optic nerve head hemangioblastoma with macular edema. Indian J Ophthalmol Case Rep [serial online] 2021 [cited 2021 Feb 26];1:67-8. Available from: https://www.ijoreports.in/text.asp?2021/1/1/67/305546



Optic nerve head hemangioblastoma is a rare retinal vascular tumour found on the optic nerve head/juxtapapillary region.[1] There is no standard treatment approach because of its peculiar location, which makes all available treatment modalities carry an inherent risk. We, herein, describe a safe and cost effective single sitting technique of photodynamic therapy (PDT) to manage such lesions.

14-year-old male presented with gradual onset vision loss in the right eye for 3 months. His BCVA in the right eye was 6/36 and in the left eye 6/6. There was an orangish red multi-lobulated vascular mass on the disc with subretinal fluid and exudation [Figure 1]. On fluorescein angiogram the lesion was intensely hyperfluorescent suggestive of the vascular nature of the lesion [Figure 2]. The patient was diagnosed as right eye optic disc hemangioblastoma with exudative macular detachment.
Figure 1: Fundus photograph of the right eye showing an orangish red multi-lobulated vascular mass on the disc (large red arrow) with surrounding large pocket of subretinal fluid (black arrow) with exudation over macula (small red arrow)

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Figure 2: (a-c) Fundus fluorescein angiography shows a lesion with early hyperfluorescence with intensely hyperfluorescent late leakage suggestive of the vascular nature of the lesion. (d) Optical coherence tomogram through the lesion shows a neurosensory detachment at the edge off the mass lesion

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Prior treatment with AntiVEGF and focal thermal laser done had a suboptimal response. A full fluence PDT was done (with 6 mg/m2 BSA intravenous vertiporfin, laser 689nm delivered at 50 J/cm2 over 83 sec), as multiple spots each of 83 sec over the tumour mass sparing the disc margin with minimal overlap [Figure 3].
Figure 3: Shows Photodynamic therapy done as multiple spots in a single sitting with each spot of 83 sec over the tumour mass sparing the disc margin with minimal overlap

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Two month post PDT, the lesion showed a significant decrease in vascularity with complete resolution of SRF [Figure 4], while maintaining the disc perfusion. BCVA stabilized at 4/60 due to subfoveal hard exudate deposition.
Figure 4: Pretreatment fundus image and optical coherence tomogram (a and b) compared with post treatment images (c and d) showing significantly decreased tumour vascularity with complete resolution of SRF with subfoveal hard exudate deposition

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  Discussion Top


PDT is a promising treatment for ONH hemangioblastoma, offering site-specific vascular occlusion and tumor destruction, with minimal damage to the adjacent neural structures. Mitropoulos et al. reported a case of small juxtapapillary hemangioblastoma treated with a single session of PDT resulting in visual improvement and regression of the lesion.[2] Schmidt-Erfurth et al. reported a case series of 5 eyes with hemangioblastoma treated with PDT, with tumor regression and resolution of macular exudates.[3] However, most cases needed multiple sittings of an expensive procedure like PDT to cover the entire mass. In our case report, we could achieve a similar result by doing a multiple spot single sitting PDT. The treatment caused the tumor to regress totally with complete resorption of fluid.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
McCabe CM, Flynn HW, Shields CL, Shields JA, Regillo CD, McDonald HR, et al. Juxtapapillary capillary hemangiomas. Ophthalmology 2000;107:2240-48.  Back to cited text no. 1
    
2.
Mitropoulos PG, Chatziralli IP, Peponis VG, Tsiotra VA, Parikakis EA. Photodynamic therapy for juxtapapillary retinal capillary hemangioma. Case Rep Ophthalmol Med 2014;2014:756840.  Back to cited text no. 2
    
3.
Schmidt-Erfurth UM, Kusserow C, Barbazetto IA, Laqua H. Benefits and complications of photodynamic therapy of papillary capillary hemangiomas. Ophthalmology 202;109:1256-66.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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