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增殖性视网膜肿瘤:病例系列中的表现、管理及结果

Vasoproliferative Retinal Tumors: Manifestations, Management, and Outcomes in a Case Series.

作者信息

Faria Pereira Ana, Teixeira-Martins Rita, Rocha-Sousa Amandio, Penas Susana

机构信息

Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal.

Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal.

出版信息

Case Rep Ophthalmol. 2024 Dec 16;16(1):27-36. doi: 10.1159/000542956. eCollection 2025 Jan-Dec.

Abstract

INTRODUCTION

Vasoproliferative retinal tumors (VPRTs) are rare, benign retinal lesions characterized by abnormal vascular proliferation. They may appear sporadically or with systemic conditions like von Hippel-Lindau disease, often resembling other retinal lesions and posing diagnostic challenges. VPRTs can lead to vision loss if not adequately managed. Current management ranges from observation to different treatment strategies, from laser photocoagulation, photodynamic therapy, cryotherapy to intravitreal injections and vitrectomy. However, optimal approach is still debated due to VPRTs' rarity and varied presentations.

CASE PRESENTATIONS

This series presents three VPRT cases. The first, a 73-year-old man who presented with sudden vision loss due to a VPRT-related vitreous hemorrhage, required multiple interventions, including vitrectomies and anti-VEGF injections, but suffered recurrent macular edema and glaucoma, requiring ongoing management. The second, a 42-year-old asymptomatic man, showed lipid exudation and peripheral retinal detachment, needing photodynamic therapy, laser, and cryotherapy. The third, a 56-year-old woman with decreased visual acuity and epiretinal membrane, achieved stability and good visual outcomes after vitrectomy with cryotherapy.

CONCLUSIONS

VPRTs pose diagnostic and therapeutic challenges given their heterogeneous presentations and potential for complications. Our cases illustrate that a multimodal management strategy - incorporating tailored combinations of therapies such as laser photocoagulation, cryotherapy, anti-VEGF injections, and surgery - is essential to address individual characteristics of each patient's disease. Personalized treatment approaches allow for precise targeting of the lesions while minimizing risk of complications, contributing to better disease stabilization and visual outcomes. Early detection and tailored management are essential, though further research is needed to establish standardized treatment protocols.

摘要

引言

视网膜血管增生性肿瘤(VPRTs)是一种罕见的良性视网膜病变,其特征为异常的血管增生。它们可能散发出现,或与诸如冯·希佩尔-林道病等全身性疾病相关,常与其他视网膜病变相似,给诊断带来挑战。如果管理不当,VPRTs可导致视力丧失。目前的管理方法包括观察以及从激光光凝、光动力疗法、冷冻疗法到玻璃体腔内注射和玻璃体切除术等不同的治疗策略。然而,由于VPRTs的罕见性和表现多样,最佳治疗方法仍存在争议。

病例报告

本系列介绍了三例VPRT病例。第一例,一名73岁男性因VPRT相关的玻璃体积血导致突然视力丧失,需要多次干预,包括玻璃体切除术和抗VEGF注射,但出现了复发性黄斑水肿和青光眼,需要持续治疗。第二例,一名42岁无症状男性,表现为脂质渗出和周边视网膜脱离,需要光动力疗法、激光和冷冻疗法。第三例,一名56岁女性视力下降且有视网膜前膜,在玻璃体切除术联合冷冻疗法后病情稳定,视力恢复良好。

结论

鉴于VPRTs表现多样且有并发症的可能性,它们带来了诊断和治疗方面的挑战。我们的病例表明,多模式管理策略——结合激光光凝、冷冻疗法、抗VEGF注射和手术等针对性的治疗组合——对于应对每位患者疾病的个体特征至关重要。个性化的治疗方法能够精确靶向病变,同时将并发症风险降至最低,有助于更好地稳定病情和改善视力。早期检测和针对性管理至关重要,不过还需要进一步研究以建立标准化的治疗方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb07/11842064/f231f7744e3e/cop-2025-0016-0001-542956_F01.jpg

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