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Clinical Image

Retinal vasoproliferative tumor with total retinal detachment

managed with plaque radiotherapy
Stephanie J. Nickerson1, Saad A. AlDahmash1,2, Carol L. Shields1, Jerry A. Shields1
1

Departments of Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University Philadelphia, PA, USA and 2Ophthalmology,
CollegeofMedicine, King Saud University, Saudi Arabia

Introduction
A 22yearold female developed painless vision loss right eye
(OD). Visual acuity was counting fingers OD, 20/20OS. The
OS was entirely normal. Examination of OD disclosed an
orangecolored retinal mass located inferotemporally, measuring
7mm in basal diameter and 4mm in thickness [Figure1]. There
was a shallow nonrhegmatogenous total retinal detachment,
intraretinal/subretinal exudation, preretinal hemorrhage and
macular edema. The features were consistent with a retinal
vasoproliferative tumor (VPT) and treatment with Iodine
I125plaque radiotherapy with a dose of 4000cGy was provided.
Eleven months later, visual acuity had improved to 20/30OD with
tumor involution and resolution of subretinal fluid and macular
edema. Four years later, visual acuity was 20/20 with stable
findings and complete regression of the VPT to a 2.0mm thick
fibrous nonvascular mass [Figure2]. There was no evidence of
radiation maculopathy or papillopathy.

Comment

Retinal VPT has become a widely recognized entity in recent

years.[15] In 1983, 12cases were reported under the name
presumed acquired retinal hemangioma, and the clinical
features were thoroughly described.[1] In 1995, the same group
reported 129VPTs in 103patients and classified this lesion
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DOI:
10.4103/0974-620X.94773

c
Figure1: Shallow exudative retinal detachment from inferotemporal active vasoproliferative
tumor (a), with macular detachment and mild edema is noted on optical coherence
tomography (b), and an echogenic mass of 4.0mm thickness by ultrasonography(c)

Copyright: 2012 Nickerson SJ, etal. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Correspondence:
Dr. Carol L. Shields, Department of Ocular Oncology Service, Suite1440, Wills Eye Institute, 840Walnut Street, Philadelphia, PA19107, USA.
Email: carol.shields@shieldsoncology.com

Oman Journal of Ophthalmology, Vol. 5, No. 1, 2012

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Nickerson, etal.: VPT plaque

into primary and secondary types.[2] This benign vascular
mass has no predilection for gender, generally found in the
inferotemporal periphery, and it can lead to serious complications
including vision loss from subretinal fluid, exudation and
retinal edema.[13] Management includes observation for
asymptomatic lesions or laser photocoagulation, cryotherapy,
photodynamictherapyorplaque radiotherapy for symptomatic
tumors.[15]

Cohen and associates reviewed 30eyes with a VPT treated with

Iodine I125plaque radiotherapy and found tumor regression
in 97% of cases, resolution of retinal detachment in 65% and
improvement of visual acuity to 20/40 or better in 37%.[4] In the
case reported here, plaque radiotherapy was successful in tumor
control and vision return.

References
1.

Shields JA, Decker WL, Sanborn GE, Augsburger JJ, Goldberg RE.
Presumed acquired retinal hemangiomas. Ophthalmology 1983;
90:1292300.
2. Shields CL, Shields JA, Barrett J, De Potter P. Vasoproliferative tumors of
the ocular fundus: Classification and clinical manifestations in 103patients.
Arch Ophthalmol 1995;113:61523.
3. Damato B. Vasoproliferative retinal tumour: Brachytherapy requires
further evaluation. Br J Ophthalmol 2006;90:399400
4. Cohen VM, Shields CL, Demirci H, Shields JA. Iodine I 125plaque
radiotherapy for vasoproliferative tumors of the retina in 30eyes. Arch
Ophthalmol 2008;126:124551.
5. Anastassiuo G, Bornfeld N, Schueler AO, Schilling H, Weber S,
Fluehs D, etal. Ruthenium106plaque brachytherapy for symptomatic
vasoproliferative tumours of the retina. Br J Ophthalmol 2006;
90:44750.

c
Figure2: At 11months following plaque radiotherapy, the detachment resolved and
visual acuity returned to 20/30. At 4year followup the retina remained flat with fibrosis
of the tumor, and minimal retinal pigment epithelial alterations (a). The macula was
slightly thinned on optical coherence tomography (b) but with 20/20visual acuity, and
ultrasonography (c) disclosed reduced thickness to 2.0mm

54

Cite this article as: Nickerson SJ, Al Dahmash SA, Shields CL, Shields JA.
Retinal vasoproliferative tumor with total retinal detachment managed with
plaque radiotherapy. Oman J Ophthalmol 2012;5:53-4.
Source of Support: Nil, Conflict of Interest: No.

Oman Journal of Ophthalmology, Vol. 5, No. 1, 2012