|Year : 1982 | Volume
| Issue : 6 | Page : 597-601
Treatment of angiomatosis retinae
B Sridhar Rao, Chandarn Abraham, Mary Abraham, TS Surenuran, SS Badrinath
Sankara Nethralaya, Medical Research Foundation 18, College Road, Madras, India
B Sridhar Rao
Sankara Nethralaya, Medical Research Foundatioh 18, College Road, Madras
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rao B S, Abraham C, Abraham M, Surenuran T S, Badrinath S S. Treatment of angiomatosis retinae. Indian J Ophthalmol 1982;30:597-601
Photocoagulation, cryo therapy and diathermy are the currently employed modes of therapy in the treatment of angiomaiesis.
| Material and method|| |
Thirteen eyes of 12 cases angioma seen here at Sankara Nethralaya forms the basis of this report. All the cases were subjected to detailed ophthalmological examination and examination by the physician to rule out associated systemic anomalies. Fluorescein angiography was performed using Carl Zeiss motorised Fundus Camera in seven cases. Eleven eyes were treated with various modes of therapy.
The age distribution of cases is given in [Table - 1].
The visual loss was related to the complications produced by the angioma as indicated in [Table - 2].
The retinal angiomas were mainly temporal in location in 9 out of the 11 eyes studied. [Table - 3] The predilection for the angiomas to be situated in the temporal side is very significant.
The angiomas were unassociated with other signs in two eyes while in all others there were associated clinical signs as indicated in [Table - 4].
The mode of presentation of single angiomatous mass has been mainly with secondary retinal detachment where as multiple angiomas presented with exudates around the mass and vitreous haemorrhage more often. [Table - 5] Three cases of multiple angiomas (cases 2, 5, & 6) had exudates in the macula which was responsible for poor vision.
The extent of retinal detachment was related to the size of the tumour as indicated in the [Table - 6] and the enclosed drawings. Smaller angiomas presented with no detachment and the extent of detachment was more with larger angiomas except in case 4. In 6 cases studied the fellow eye was normal ; in 5 cases the fellow eye was lost to complication produced by angiomas ; one case (case 10) of disc angioma had an uncomplicated retinal angiorna had an uncomplicated retinal angioma in the fellow eye. [Table - 7].
There were no associated systemic involvement in all the cases studied.
| Fluorescein angiography|| |
Fluorescein angiography was performed in six cases with retinal angioma and one of optic disc angioma. The angiography of the mass was difficult because of the peripheral location of the lesion in most cases. Profuse leakage of the dye from the mass was observed in four cases (case 1, 2, 3 and 9) one had minimal leakage (case 7) and one did not show leakage of the dye from the tumour situated in the optic disc. (case 10) Rapid emptying of the dye was observed in two cases (case 7 and 10).
Loss of capillaries associated with compensatory dilatation of remaining capillaries around the mass was observed in four cases case 2, 3, 7 and 10). Angiography was helpful in the diagnosis of a suspected retinal hole as an angioma (case 9).
The complications produced by the angioma called for treatment in most of the cases ; in 2 cases the fellow eye had complications produ. ced by angiomas. which prompted us to treat uncomplicated angiomas. [Table - 8] The various methods of treatment followed is indicated in [Table - 9]
| Cryo therapy|| |
Cryotherapy was employed to destroy the angiomatous mass causing secondary retinal detachment (case 7). We used the triple freeze thaw technique of cryocoagulation described by Amoils.
One patient (case 3) who had a subtotal retinal detachment caused by a retinal angioma was treated with cryotherapy as above, combined with scleral buckling procedure using solid silicone implant and encircling band.
Six cases were treated by the xenon arc photocoagulation. The usual spot size employed was 6, power 3, and timing 0.5 sees. The treatment was directly applied to the tumour mass and gradual shrinkage was obtained over 2 to 5 sessions of treatment.
Argaon Laser photocoagulation alone was employed in the treatment of two cases. One case was angioma of the disc (case 11) with secondary retinal detachment and the other was a case of multiple angiomas of the retina. (Case 2). The sittings were spot size 200 power 0.3 and timing 0.1 sec. The treatment was directed over the tumour mass and gradual shrinkage was obtained over to four to five sessions of treatment.
One case (case 7) of angioma of retina was treated with both Xenon are and argon laser photocoagulation.
| Observations and discussion|| |
Xenon are photocoagulation was employed in 6 cases of angiomatosis retinae. In all six cases there was marked reduction in the size of the tumour and the feeder vessels, There was improvement in the visual acuity in two cases. (case 4 and 9 due to absorption of vitreous haemorrhage). [n three cases the visual acuity was maintained. In one case the visual acuity improved from 6/60 to 6/12 but after nearly two years the visual acuity had dropped to 3/60 due to extensive pre-retinal membranes and vitrectomy was contemplated, The other complications encountered were exudative retinal detachment small intraretinal haemorrhage and small vitreous haemorrhage, These were of minor nature requiring no spe. cific treatment and resolved spontaneously, [Table - 10].
Argon laser photocoagulation : Two cases treated with argon laser photocoagulation did very well. One case was an angioma of the optic disc 1-2 1 DD to 2 DD in size with localised secondary retinal detachment. (case 11) The tumour shrank in size completely and the secondary detachment completely disappeared The visual acuity which was counting fingers at one meter distance was maintained. There was improvement in the field tests as evidenced by the degrease in the areas of absolute and relative scotoma following treatment.
One case (case 2) of multiple retinal an• gioma responded very well to laser photocoagulation with shrinkage of the tumour and feeder vessels. The visual acuity was maintained over a six month follow up and complications due to treatment were of a minor nature, requiring no specific treatment.
One patient (case 8) with an angioma of about 5 DD size with secondary retinal detachment was subjected initially to xenon are photocoagulation and later with laser photocoagulation. This patient responded well to treatment with improvement in visual acuity from CF at 4 meter distance to 6/36 over a 2 month follow up. The mass had become smaller and the secondary detachment had become much less.
| Cryotherapy|| |
It was done in one case sna was successful in causing shrinkage of the tumour mass and there was more than 50% reduction in the size of the feeder vessels. The secondary retinal detachment almost completely disappeared. The visual acuity was maintained. There was a follow up of three months.
Cryotherapy combined with seleral buckling using solid silicone implant and encircling band was successful in the reattachment of retina in another case. There was marked shrinkage of the tumour and reduction in the size of the feeder vessels to near normal size. There was an improvement in the visual acuity from counting fingers close to face to 1/60. The patient had a follow up of four months. No complications were encountered in the above procedured.
| Fluorescein angiography|| |
Post treatment angiography was performed in two cases. One (case 9) had xenon photocoagulation 2 months before. It showed no significant change in the affarent vessels and persistence of dye leakage from two masses.
Post treatment angiography performed one month after cryotherapy (case 7) showed considerable reduction in the size of the tumour and the feeder vessels. This was a beaded appearance of one of the affarent vessels. This was probably due to intense cryo reaction.
| Summary|| |
Twelve cases of angioma are presented. Eleven of these cases who were subjected to various methods of treatment are discussed. The technique of treatment, the response to treatment and the complications encountered are outlined.
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7], [Table - 8], [Table - 9], [Table - 10]