Session Title: Free Paper Session 15: Mixed Session
Session Date/Time: Friday 08/09/2017 | 16:30-18:00
Paper Time: 17:00
Venue: Room 117
First Author: : J.Walinjkar INDIA
Co Author(s): : U. Sharma P. Rishi E. Rishi L. Gopal T. Sharma
VPT are rare, benign tumours of retina, with peripheral predilection but can cause remote effects on macula with vision threatening manifestations like cystoid macular edema, epiretinal membrane, exudation or tractional retinal detachment. The purpose of our study is to describe the clinical features and treatment outcomes of VPT in Indian subjects.
Vitreoretina services, Tertiary eye care centre, Southern India.
A retrospective case series. Case records of patients either diagnosed or referred with diagnosis of VPT were screened from 2011 to 2015. The cases confirmed as VPT on the basis of ophthalmoscopic finding or imaging modalities like Fundus Fluorscein Angiography and Ultrasound were included in the study. Demographic details, ocular examination findings, tumour associated features, treatment modalities, complications and follow-up course was reviewed. The data collected on continuous and ordinal scale was expressed as mean, median and range. Comparison between the baseline and follow up characteristics of tumours and between primary and secondary tumours was done by converting the data into percentages. SPSS version 14 was used for statistical analysis. P value less than 0.05 was considered significant.
Twenty-two tumours from 19 eyes of 17 patients were included in the study. Mean age at presentation was 43.5 years (range-15-68 years). Mean presenting BCVA was +1.10 Log MAR. Secondary tumours were found in 68% eyes. At presentation, mean basal tumour dimension of primary tumours was 7.17 mm and secondary tumours was 9.92 mm. Most common association of secondary VPT was Coats’ disease (n=5) followed by retinal vasculitis (n=2), Polypoidal choroidal vasculopathy (n=2), Familial exudative vitreorretinopathy (n=2) and traumatic chorioretinopathy (n=2). Ten tumours (45%) involved the inferior quadrant. tumour associated features were intra/sub-retinal exudates (n=14), vitritis (n=7), sub-retinal fluid (n=5), vitreous haemorrhage (n=3), pre-retinal fibrosis (n=3), epiretinal membrane (n=3) and sub-retinal blood (n=2). Treatment included transconjunctival cryotherapy (n=9), intravitreal or oral steroids (n=4), laser (n=3), transconjunctival cryotherapy with encirclage (n=1), transconjunctival cryotherapy with antiVEGF (n=1) and observation (n=3). Thirteen tumours regressed at first follow-up, seven (primary = 2; secondary = 5) needed more treatments. Complications included tumour recurrence (n=5), retinal detachment (n=2), raised IOP (n=2) and cataract (n=3). 95% VPT regressed at mean 21 months (Median-17 months; Range – 3-64 months). Mean final BCVA was +1.21 Log MAR. There was significant reduction in mean basal tumour dimension at final follow-up.
To the best of our knowledge, this is the first largest case series in Indian subjects describing the clinical features and treatment outcomes in VPT. Bilaterality, post-equatorial location, and multifocal VPT were rare. The basal tumour dimensions in secondary tumours were found to be more as compared to primary tumours at baseline. Cryotherapy either alone or combined with other treatment modalities was effective in both primary and secondary VPT in majority of cases. Contrary to published literature, secondary tumours are more common in Indian subjects having worse visual acuity and outcome, requiring more number of treatment sessions and have increased tendency to recur after complete regression. We recommend close follow up to look for recurrences and rhegmatogenous retinal detachment even after complete regression of VPT so that these eyes can be salvaged with reasonably good anatomical and visual outcome.