Purpose:

To illustrate a personal approach to the accidental intraoperative finding of a very large (8mm max. diameter) Vasoproliferative Retinal Tumor (VPRT) during Phacovitrectomy for long-standing Coat’s disease.

Background:

VPRTs are benign, vascular masses located in the peripheral retina. Shields and Coworkers have classified them as idiopathic or secondary to congenital, inflammatory, vascular, traumatic, dystrophic or degenerative vitreoretinal pathology. Reported treatments for VPRTs are laser photocoagulation, cryotherapy, plaque radiotherapy, transscleral resection, vitrectomy surgery, and more recently photodynamic therapy. In ICG-Mediated Photothrombosis (ICG-MP) the goal of the treatment is achieving laser-induced vascular tissue damage, leading to vascular occlusion and secondary obliteration of the targeted lesion. Interaction between intralesional ICG and infrared diode laser at 810 nm has been proven to enhance laser photocoagulation effect of diode laser, and to permit lower fluence use in Transpupillary Thermotherapy. It has also been proven to determine highly selective damage of vessels in animal models.

Methods:

A very large (9 mm maximum diameter) VPRT was accidentally found during phacovitrectomy for long-standing Coat’s Disease. During vitrectomy the choice of performing intraoperative tumor ablation was ruled out. Intraoperative Cryocoagulation was performed, without success, due to the excessive dimension of the VPRT. Subsequent, postoperative ICG-MP in 4 different ambulatory sessions was performed, aiming the late pooling/staining of ICG within the lesion. Confluent, 2mm large, 1minute long near-Infrared (810 nm) laser exposures were applied to the lesion in each session, covering its whole extent. Pain perceived by the patient during infrared laser treatment was used as a guide for the intensity of single exposures.

Results:

The combined Treatment achieved obliteration of the vascular tumor. Follow-up has now reached 6 months. Personal successful results of this technique in the treatment of further 5 cases of vascular retinal tumors will be shown.

Conclusions / Take Home Message:

ICG-mediated Photothrombosis is a very efficient technique in the treatment of selected vascular retinal tumors, and should be considered as an alternative to more invasive surgical treatments.

Contact Details:

Email: enrbertelli@gmail.com
Cell Phone: +393409191017