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Clinicopathologic Reports, Case Reports, and Small Case Series |

Resolution of Exudative Retinal Detachment From Retinal Astrocytoma Following Photodynamic Therapy FREE

Carol L. Shields, MD; Miguel A. Materin, MD; Brian P. Marr, MD; Jaime Krepostman, MD; Jerry A. Shields, MD
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Section Editor: W. Richard Green, MD

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Arch Ophthalmol. 2008;126(2):273-274. doi:10.1001/archophthalmol.2007.54.
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An 18-year-old woman with a visual acuity of 20/70 OD from an exudative macular retinal astrocytoma confirmed by needle biopsy was treated with photodynamic therapy (PDT). Subsequent resolution of subretinal fluid and intraretinal edema led to improvement in vision during 6 months.

Acquired retinal astrocytoma is a benign intraocular tumor typically located in the macular or juxtapapillary region.1,2Despite its benign cytology, progressive growth, exudation, and secondary retinal detachment, acquired retinal astrocytoma can lead to poor visual acuity or enucleation.1,2Current therapies include laser photocoagulation, plaque radiotherapy, external beam radiotherapy, and enucleation. In this report, we describe a patient with retinal astrocytoma who showed resolution of macular edema and exudation following PDT.

REPORT OF A CASE

An 18-year-old woman had an asymptomatic retinal mass with exudative retinopathy in her right eye. Visual acuity was 20/20 OU. She had no history of tuberous sclerosis complex or neurofibromatosis. The left eye had normal vision. In the temporal macular region of the right eye, there was an amelanotic retinal tumor with slight intrinsic grey pigmentation measuring 6.0 mm in diameter and 3.0 mm thick. There were slightly dilated feeding and draining vessels. Optical coherence tomography showed shallow subretinal fluid and macular edema. The clinical diagnosis was acquired retinal astrocytoma rule-out pigment epithelial adenoma. Transvitreal fine-needle aspiration biopsy through the pars plana revealed amelanotic bland spindle and stellate cells with cytoplasmic processes without mitoses.

Immunohistochemistry showed a strong reaction to glial fibrillary acidic protein and a negative reaction to melanoma-specific antigen (HMB-45), suggesting the diagnosis of astrocytoma. Observation was advised.

Nine months later, the exudation had increased, but visual acuity was stable. Subsequently, visual acuity decreased from macular exudation, edema, and subretinal fluid to 20/25 OD (at 15 months) and 20/60 OD (at 16 months). Argon laser photocoagulation to the tumor surface and surrounding retina was provided. Visual acuity continued to decrease to 20/70 OD at 17 months, so PDT was performed (Figure). The entire astrocytoma was treated with a single 83-second laser spot at 689 nm (50 J/cm2) following intravenous verteporfin (6 mg/m2). After treatment, resolution of macular exudation, edema, and subretinal fluid led to improved vision of 20/50 OD (at 1 month) and 20/30 OD (at 4, 8, and 12 months). The tumor showed minimal involution with decreased intrinsic vascularity.

Place holder to copy figure label and caption
Figure.

An 18-year-old woman with poor visual acuity from biopsy-proven retinal astrocytoma showed improvement in vision following photodynamic therapy (PDT) to the tumor. A, Before PDT, there was progressive visual deterioration due to serous retinal detachment, exudation, and edema. Visual acuity was 20/70 OD. Argon laser photocoagulation had failed to resolve the retinal findings. Photodynamic therapy was performed with a single 83-second laser spot to the entire tumor. B, Before PDT, optical coherence tomography showed foveal edema and exudation. C, Four months after PDT, the retinal detachment, exudation, and edema showed gradual resolution, and visual acuity improved to 20/30 OD. Continued resolution of exudation was noted at 1-year follow-up. D, Four months after PDT, optical coherence tomography showed resolution of the foveal edema and persistent extrafoveal exudation that gradually resolved during 1-year follow-up.

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COMMENT

Benign retinal astrocytic tumors include astrocytic hamartoma, acquired astrocytoma, and reactive retinal gliosis.1Astrocytic hamartoma is typically stable, recognized in early childhood, and often found in patients with tuberous sclerosis complex or neurofibromatosis.1,3Acquired astrocytoma is a sporadic tumor with progressive growth, retinal detachment, and poor visual acuity and requires enucleation.1,2This tumor is typically found in young or middle-aged adults and is not associated with tuberous sclerosis complex. Retinal gliosis generally occurs following trauma, inflammation, or infection.

Acquired retinal astrocytoma shows poor response to laser photocoagulation and radiotherapy. Mennel and associates4described a similar case in which an astrocytoma produced a visual acuity of 20/200 OD from serous retinal detachment, exudation, and edema. After 166 seconds of PDT, the retinal findings gradually cleared during 1 year, with a final visual acuity of 20/30 OD. Surprisingly, the tumor nearly completely disappeared. In our case, the retinal findings and visual acuity cleared, but the tumor showed trace reduction in size at 8 months following PDT.

In other fields of oncology, the photodynamic technique is important in the detection and treatment of tumors, particularly brain tumors, such as malignant gliomas, metastatic tumors, and meningiomas. Photodynamic therapy provides targeted destruction of remaining tumor cells following surgical excision and has been shown to increase patient survival.5

ARTICLE INFORMATION

Correspondence:Dr C. L. Shields, Ocular Oncology Service, Wills Eye Institute, Ste 1440, 840 Walnut St, Philadelphia, PA 19107 (carol.shields@shieldsoncology.com).

Author Contributions:Dr C. L. Shields had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Financial Disclosure:None reported.

Funding/Support:This study was supported by the Retina Research Foundation of the Retina Society, Cape Town, South Africa (Dr C. L. Shields), the Paul Kayser International Award of Merit in Retina Research, Houston, Texas (Dr J. A. Shields), Michael, Bruce, and Ellen Ratner, New York, New York (Drs C. L. Shields and J. A. Shields), the Mellon Charitable Giving from the Martha W. Rogers Charitable Trust, Philadelphia, Pennsylvania (C. L. Shields), the LuEsther Mertz Retina Research Foundation, New York (C. L. Shields), and the Eye Tumor Research Foundation, Philadelphia (Drs C. L. Shields and J. A. Shields).

REFERENCES

Shields  JAShields  CL Glial tumors of the retina and optic disc. Shields  JAShields  CLAtlas of Intraocular Tumors. Philadelphia, PA Lippincott Williams & Wilkins1999;269- 286
Shields  CLShields  JAEagle  RC  JrCangemi  F Progressive enlargement of acquired retinal astrocytoma in two cases. Ophthalmology 2004;111 (2) 363- 368
PubMed Link to Article
Zimmer-Galler  IERobertson  DM Long-term observation of retinal lesions in tuberous sclerosis. Am J Ophthalmol 1995;119 (3) 318- 324
PubMed
Mennel  SHausmann  NMeyer  CHPeter  S Photodynamic therapy for exudative hamartoma in tuberous sclerosis. Arch Ophthalmol 2006;124 (4) 597- 599
PubMed Link to Article
Eljamel  MS New light on the brain: the role of photosensitizing agents and laser light in the management of invasive intracranial tumors. Technol Cancer Res Treat 2003;2 (4) 303- 309
PubMed

Figures

Place holder to copy figure label and caption
Figure.

An 18-year-old woman with poor visual acuity from biopsy-proven retinal astrocytoma showed improvement in vision following photodynamic therapy (PDT) to the tumor. A, Before PDT, there was progressive visual deterioration due to serous retinal detachment, exudation, and edema. Visual acuity was 20/70 OD. Argon laser photocoagulation had failed to resolve the retinal findings. Photodynamic therapy was performed with a single 83-second laser spot to the entire tumor. B, Before PDT, optical coherence tomography showed foveal edema and exudation. C, Four months after PDT, the retinal detachment, exudation, and edema showed gradual resolution, and visual acuity improved to 20/30 OD. Continued resolution of exudation was noted at 1-year follow-up. D, Four months after PDT, optical coherence tomography showed resolution of the foveal edema and persistent extrafoveal exudation that gradually resolved during 1-year follow-up.

Graphic Jump Location

Tables

References

Shields  JAShields  CL Glial tumors of the retina and optic disc. Shields  JAShields  CLAtlas of Intraocular Tumors. Philadelphia, PA Lippincott Williams & Wilkins1999;269- 286
Shields  CLShields  JAEagle  RC  JrCangemi  F Progressive enlargement of acquired retinal astrocytoma in two cases. Ophthalmology 2004;111 (2) 363- 368
PubMed Link to Article
Zimmer-Galler  IERobertson  DM Long-term observation of retinal lesions in tuberous sclerosis. Am J Ophthalmol 1995;119 (3) 318- 324
PubMed
Mennel  SHausmann  NMeyer  CHPeter  S Photodynamic therapy for exudative hamartoma in tuberous sclerosis. Arch Ophthalmol 2006;124 (4) 597- 599
PubMed Link to Article
Eljamel  MS New light on the brain: the role of photosensitizing agents and laser light in the management of invasive intracranial tumors. Technol Cancer Res Treat 2003;2 (4) 303- 309
PubMed

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