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Carol L Shields - One of the best experts on this subject based on the ideXlab platform.
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photodynamic therapy for circumscribed Choroidal Hemangioma in 79 consecutive patients comparative analysis of factors predictive of visual outcome
Ophthalmology Retina, 2020Co-Authors: Maura Di Nicola, Jerry A Shields, Arman Mashayekhi, Basil K Williams, Archana Srinivasan, Saad Aldahmash, Carol L ShieldsAbstract:Purpose To determine factors predictive of visual outcome in patients with circumscribed Choroidal Hemangioma treated with photodynamic therapy (PDT). Design Retrospective case series. Participants Seventy-nine patients with circumscribed Choroidal Hemangioma treated with PDT. Methods Patients with circumscribed Choroidal Hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed. Main Outcome Measures Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse. Results Seventy-nine eyes of 79 patients with circumscribed Choroidal Hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0–10.0 mm); mean thickness was 3.0 mm (range, 1.4–4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0–7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P Conclusions In this comparative analysis, PDT was an effective treatment method for circumscribed Choroidal Hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.
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circumscribed Choroidal Hemangioma visual outcome in the pre photodynamic therapy era versus photodynamic therapy era in 458 cases
Ophthalmology Retina, 2020Co-Authors: Carol L Shields, Lauren A Dalvin, Lianne S Lim, Michael Chang, Sanika Udyaver, Mehdi Mazloumi, Pornpattana Vichitvejpaisal, Eleni Florakis, Arman Mashayekhi, Jerry A ShieldsAbstract:Purpose To analyze visual outcomes after treatment of Choroidal Hemangioma in the pre-photodynamic therapy (PDT) era versus PDT era. Design Retrospective, comparative case series. Participants A total of 458 patients with circumscribed Choroidal Hemangioma. Methods Comparison of Hemangioma managed in the pre-PDT (1967–2001) era versus PDT (2002–2018) era. Main Outcome Measure Visual acuity outcome. Results A total of 458 tumors were treated over this 51-year period. A comparison (pre-PDT [n = 220 cases] vs. PDT [n = 238 cases]) revealed PDT era patients were of older mean age (48.9 vs. 53.8 years, P = 0.002) and were more likely to have systemic hypertension (17.7% vs. 33.8%, P Conclusions Management of Choroidal Hemangioma in the PDT era has allowed for significantly better visual outcome compared with the pre-PDT era, with mean final visual acuity of 20/400 (pre-PDT era) versus 20/63 (PDT era).
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parafoveal microvascular features on optical coherence tomography angiography in eyes with circumscribed Choroidal Hemangioma
Retina-the Journal of Retinal and Vitreous Diseases, 2017Co-Authors: Kareem Sioufi, Emil Anthony T Say, Sandor C Ferenczy, Carol L ShieldsAbstract:Purpose To evaluate parafoveal microvasculature in eyes with circumscribed Choroidal Hemangioma using optical coherence tomography angiography. Methods Fourteen eyes with unilateral circumscribed Choroidal Hemangioma were imaged using OCT for central macular thickness and optical coherence tomography angiography for superficial and deep foveal avascular zone area, and superficial and deep capillary density (CD), comparing affected and paired fellow eyes. Results Mean patient age was 53 years, and mean visual acuity was 20/60 in the involved eye and 20/25 in the fellow eye. In the affected eye, clinical findings included cystoid macular edema (CME) in 1, parafoveal/subfoveal subretinal fluid (SRF) in three, and both CME and SRF in two eyes. OCT revealed current CME/SRF in six eyes, and normal foveal contour in eight eyes, among which five never demonstrated OCT evidence of CME or SRF. By OCT (affected vs. fellow eye), mean central macular thickness was greater in affected eyes (312 vs. 264 μm, P = 0.042). By optical coherence tomography angiography, there was no difference in superficial foveal avascular zone (P = 0.327), deep foveal avascular zone (P = 0.563), and superficial CD (P = 0.159), but mean deep plexus CD was reduced in affected eyes (50% vs. 54%, P = 0.010). Subgroup analysis showed that eyes with previous or current CME and/or SRF had reduced deep plexus CD (53% vs. 57%, P = 0.005), while eyes without previous/current CME/SRF had similar deep plexus CD (P = 0.399) compared with fellow eyes. Conclusion Circumscribed Choroidal Hemangioma generally does not affect parafoveal inner retinal microvasculature. However, a reduction in deep plexus CD can be expected in eyes with previous or current CME/SRF.
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dome shaped macula simulating Choroidal Hemangioma in a myopic patient
Oman Journal of Ophthalmology, 2015Co-Authors: Prashanth G Iyer, Emil Anthony T Say, Carol L ShieldsAbstract:To describe a case of dome-shaped macula simulating a Choroidal Hemangioma and discuss multimodal imaging features to distinguish between these disorders. A 52-year-old myopic male with a refraction of -8.00 D in both eyes developed blurred vision in the left eye OS) over 4 years. Fundus examination of the right eye (OD) was unremarkable. In OS, there was a subtle orange-colored mass in the macular region with subretinal fluid, suggestive of Choroidal Hemangioma. Upon referral, our examination disclosed an echodense mass on ultrasonography of OS, measuring 1.0 mm thickness, and additional staphyloma was noted. Enhanced depth imaging optical coherence tomography (EDI-OCT) confirmed subfoveal fluid over a dome-shaped mass that originated in the sclera and not the choroid, consistent with the dome-shaped macula. The OD showed similar features, but to a lesser degree. Both eyes demonstrated Choroidal thinning on EDI-OCT, related to high myopia. Dome-shaped macula can masquerade as Choroidal Hemangioma, especially when associated with subretinal fluid. In these cases, EDI-OCT can document "tumor" origin from within the sclera and not the choroid.
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enhanced depth imaging optical coherence tomography of circumscribed Choroidal Hemangioma in 10 consecutive cases
Middle East African Journal of Ophthalmology, 2015Co-Authors: Duangnate Rojanaporn, Sandor C Ferenczy, Swathi Kaliki, Carol L ShieldsAbstract:Purpose: The purpose was to evaluate the features of circumscribed Choroidal Hemangioma using spectral-domain enhanced depth imaging optical coherence tomography (EDI-OCT). Design: Retrospective observational case series. Participants: Ten patients with newly diagnosed circumscribed Choroidal Hemangioma. Methods: Spectral-domain EDI-OCT was performed with a Heidelberg Spectralis HRA + OCT (Heidelberg Engineering, Heidelberg, Germany). Main Outcome Measures: Tumor thickness and EDI-OCT features. Results: The mean tumor diameter for all eyes was 5.4 mm and mean tumor thickness was 1187 mm by EDI-OCT compared to 2400 mm by ultrasonography. EDI-OCT imaged all tumors as smooth with a gently sloping anterior contour, gradual Choroidal expansion, expansion of medium and large size Choroidal vessels without compression of choriocapillaris, and intact Bruch's membrane (n = 10, 100%). The height of the medium and large Choroidal vessels within the tumor compared to normal medium and large vessels was comparatively increased by a mean of 265% (medium vessels) and 576% (large vessels). Outer retinal abnormalities included subretinal fluid (n = 7, 70%), lipofuscin deposition (n = 1, 10%), irregularity and thinning of retinal pigment epithelium and absence or irregularity of the ellipsoid layer (n = 4, 40%), absent external limiting membrane (n = 2, 20%), and disruption of the outer nuclear layer and outer plexiform layer (n = 3, 30%). The inner retinal abnormalities included irregularity of inner nuclear layer and structural loss or edema of inner plexiform layer (n = 3, 30%). The ganglion cell layer and nerve fiber layer were intact (n = 10, 100%). Conclusion: EDI-OCT of circumscribed Choroidal Hemangiomas depicts a smooth, gently sloping Choroidal mass with expansion of medium and large size Choroidal vessels without compression of the choriocapillaris. Structural abnormalities of outer and inner retinal layers were noted.
Jerry A Shields - One of the best experts on this subject based on the ideXlab platform.
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photodynamic therapy for circumscribed Choroidal Hemangioma in 79 consecutive patients comparative analysis of factors predictive of visual outcome
Ophthalmology Retina, 2020Co-Authors: Maura Di Nicola, Jerry A Shields, Arman Mashayekhi, Basil K Williams, Archana Srinivasan, Saad Aldahmash, Carol L ShieldsAbstract:Purpose To determine factors predictive of visual outcome in patients with circumscribed Choroidal Hemangioma treated with photodynamic therapy (PDT). Design Retrospective case series. Participants Seventy-nine patients with circumscribed Choroidal Hemangioma treated with PDT. Methods Patients with circumscribed Choroidal Hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed. Main Outcome Measures Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse. Results Seventy-nine eyes of 79 patients with circumscribed Choroidal Hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0–10.0 mm); mean thickness was 3.0 mm (range, 1.4–4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0–7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P Conclusions In this comparative analysis, PDT was an effective treatment method for circumscribed Choroidal Hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.
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circumscribed Choroidal Hemangioma visual outcome in the pre photodynamic therapy era versus photodynamic therapy era in 458 cases
Ophthalmology Retina, 2020Co-Authors: Carol L Shields, Lauren A Dalvin, Lianne S Lim, Michael Chang, Sanika Udyaver, Mehdi Mazloumi, Pornpattana Vichitvejpaisal, Eleni Florakis, Arman Mashayekhi, Jerry A ShieldsAbstract:Purpose To analyze visual outcomes after treatment of Choroidal Hemangioma in the pre-photodynamic therapy (PDT) era versus PDT era. Design Retrospective, comparative case series. Participants A total of 458 patients with circumscribed Choroidal Hemangioma. Methods Comparison of Hemangioma managed in the pre-PDT (1967–2001) era versus PDT (2002–2018) era. Main Outcome Measure Visual acuity outcome. Results A total of 458 tumors were treated over this 51-year period. A comparison (pre-PDT [n = 220 cases] vs. PDT [n = 238 cases]) revealed PDT era patients were of older mean age (48.9 vs. 53.8 years, P = 0.002) and were more likely to have systemic hypertension (17.7% vs. 33.8%, P Conclusions Management of Choroidal Hemangioma in the PDT era has allowed for significantly better visual outcome compared with the pre-PDT era, with mean final visual acuity of 20/400 (pre-PDT era) versus 20/63 (PDT era).
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circumscribed Choroidal Hemangioma clinical features and outcomes by age category in 458 cases
Saudi Journal of Ophthalmology, 2019Co-Authors: Lauren A Dalvin, Lianne S Lim, Michael Chang, Sanika Udyaver, Mehdi Mazloumi, Pornpattana Vichitvejpaisal, Eleni Florakis, Arman Mashayekhi, Jerry A ShieldsAbstract:Abstract Purpose To investigate features and outcomes of circumscribed Choroidal Hemangioma by patient age. Methods Retrospective review of circumscribed Choroidal Hemangioma from 3/29/1967–6/4/2018 based on age at presentation (≤20 vs. >20–50 vs. >50 years). Results There were 458 circumscribed Choroidal Hemangiomas diagnosed at mean age (13 vs. 41 vs. 64 years, p Conclusion Younger patients (≤20 years) with circumscribed Choroidal Hemangioma present with worse visual acuity and larger, more posterior tumors. Future studies are needed to improve early detection and treatment for this subgroup of patients.
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sector iris Hemangioma in association with diffuse Choroidal Hemangioma
Journal of Aapos, 2015Co-Authors: Carol L Shields, Hatice Tuba Atalay, Wadakarn Wuthisiri, Alex V Levin, Sara E Lally, Jerry A ShieldsAbstract:Two patients referred for iris lesions were found to have sector Hemangioma of the iris stroma in contiguity with diffuse Choroidal Hemangioma. Neither patient had other manifestations of Sturge-Weber syndrome.
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autofluorescence of Choroidal Hemangioma in 34 consecutive eyes
Retina-the Journal of Retinal and Vitreous Diseases, 2010Co-Authors: Aparna Ramasubramanian, Carol L Shields, Sarah A Harmon, Jerry A ShieldsAbstract:Purpose: The purpose of this study was to describe the autofluorescence (AF) features of Choroidal Hemangioma in 34 consecutive patients. Methods: Standard fundus photography and AF photography (580-nm excitation, 695-nm barrier filter) were performed on all patients. The clinical features were correlated with AF features. The main outcome measures were autofluorescence features of Choroidal Hemangioma (intrinsic AF) and overlying retinal pigment epithelium (extrinsic AF). Results: There were 27 eyes with circumscribed Choroidal Hemangioma (CCH) and 7 eyes with diffuse Choroidal Hemangioma (DCH). The mean patient age was 53 years for CCH and 15 years for DCH. Intrinsic AF of untreated CCH was generally iso-AF (n = 7, 58%) and for treated CCH was hypo-AF (n = 15, 100%). Extrinsic AF of CCH disclosed hyper-AF (orange pigment and fresh subretinal fluid) and hypo-AF (retinal pigment epithelium hyperplasia, fibrous metaplasia, and atrophy). Intrinsic AF of untreated DCH was generally hypo-AF (n = 2, 67%) and for treated DCH was hypo-AF (n = 3, 75%). Extrinsic AF of DCH was similar to CCH. Conclusion: Choroidal Hemangioma shows little intrinsic AF. Overlying orange pigment and fresh subretinal fluid show hyper-AF and retinal pigment epithelium hyperplasia and atrophy show hypo-AF.
Sung Chul Lee - One of the best experts on this subject based on the ideXlab platform.
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gamma knife radiosurgery for Choroidal Hemangioma a single institute series
World Neurosurgery, 2020Co-Authors: Kyu Seon Chung, Sung Chul Lee, Won Seok Chang, Jong Hee Chang, Jin Woo Chang, Yong Gou Park, Hyun Ho JungAbstract:Objective Choroidal Hemangioma (CH) is a benign vascular tumor that induces subretinal fluid collection or exudative retinal detachment and consequent visual symptoms. Current standard treatments for CH include cryotherapy, diathermy, photocoagulation, photodynamic therapy, transpupillary thermotherapy, and radiation therapy. Stereotactic radiosurgery has recently been applied to the treatment of CH because of its characteristic stiff dose-fall-off and accuracy. We have adopted gamma knife radiosurgery (GKRS) to treat CH and have retrospectively assessed tumor volume reductions and improvements to visual acuity achieved thereby. Methods Fourteen patients with CHs were treated with GKRS from November 2006 to December 2017. Eight patients had circumscribed CH, and 6 exhibited diffuse CHs and were diagnosed with Sturge-Weber syndrome. The mean age of patients was 27.1 years (range: 8–68 years) and the mean duration of clinical or radiological follow-up was 40.2 months (range: 5–105 months). The mean volume of the tumors at the time of GKRS was 533.5 mm3 (range: 124–1150 mm3), and the mean prescribed marginal dose was 11.6 Gy (range: 10–16 Gy) with 50% isodose lines. Results The tumor volume decreased by the last follow-up in all patients. The visual acuity improved in 9 patients (64%) and decreased in 1 (7%). Six patients (43%) required trans-pars plana vitrectomy before or after GKRS. There were no symptomatic complications from radiation injury during the follow-up periods. Conclusions GKRS could be an acceptable alternative treatment for symptomatic CH when standard therapy is not feasible.
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efficacy of double dose photodynamic therapy for circumscribed Choroidal Hemangioma
Retina-the Journal of Retinal and Vitreous Diseases, 2017Co-Authors: Ji Hwan Lee, Christopher Seungkyu Lee, Sung Chul LeeAbstract:Purpose To evaluate the efficacy of photodynamic therapy using a double dose of verteporfin for patients with circumscribed Choroidal Hemangioma. Methods This retrospective comparative case series evaluated data from 10 patients who were treated using double dose photodynamic therapy (12 mg/m) and seven patients who were treated using the standard dose (6 mg/m). A laser was applied with a radiant exposure of 50 J/cm. The ophthalmologic examinations were performed at baseline and 1 year after the treatment and included best-corrected visual acuity, slit-lamp biomicroscopy, fundus examination, spectral domain optical coherence tomography, and B-scan ultrasonography. Results The mean age in the double dose group was 51.60 years, compared with 50.57 years in the standard-dose group. The only significant difference between the two groups' baseline characteristics was observed in their initial tumor heights. Foveal center thickness, subretinal fluid, and subfoveal Choroidal thickness decreased significantly at 1 year after treatment in both groups. Tumor height and the greatest linear dimension of the tumor's base only decreased significantly in the double dose group (P = 0.031). Both groups did not experience significant visual improvements. Conclusion Double dose photodynamic therapy was effective and safe for treating circumscribed Choroidal Hemangioma and provided better tumor regression with similar resorption of subretinal fluid, compared with standard-dose photodynamic therapy.
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treatment of serous macular detachment associated with circumscribed Choroidal Hemangioma
American Journal of Ophthalmology, 2012Co-Authors: Hee Jung Kwon, Min Kim, Christopher Seungkyu Lee, Sung Chul LeeAbstract:Purpose To evaluate the effects of transpupillary thermotherapy and intravitreal bevacizumab injection on serous macular detachment and cystoid macular edema (CME) associated with circumscribed Choroidal Hemangioma. Design Retrospective, interventional case series. Methods We reviewed the records of 12 patients with circumscribed Choroidal Hemangioma treated with transpupillary thermotherapy and/or intravitreal injection of bevacizumab. We assessed changes in best-corrected visual acuity (BCVA), central foveal thickness by optical coherence tomography, and resolution of serous macular detachment and CME. Results Six of 8 patients treated with transpupillary thermotherapy showed complete resolution of serous macular detachment and CME and the median minimal angle of resolution (logMAR) BCVA improved from 0.85 to 0.35 ( P = .026). Among these 6 patients, 1 had no recurrence for 86 months and 5 had sustained resolution of serous macular detachment for a mean duration of 32.8 months before recurrence. Among the 9 patients treated with bevacizumab (including 5 patients who had transpupillary thermotherapy as a primary treatment), 5 showed resolution of serous macular detachment and the median logMAR BCVA improved from 0.7 to 0.5 ( P = .042). Among these 5 patients, 3 had sustained resolution for a mean duration of 5.7 months and 2 showed recurrent serous macular detachment after 3 and 12 months. Conclusion Transpupillary thermotherapy and intravitreal bevacizumab appear effective in the management of symptomatic circumscribed Choroidal Hemangioma, although recurrence of serous macular detachment and CME developed after long-term follow-up of transpupillary thermotherapy, and the duration of treatment effectiveness appears to be short with bevacizumab.
Arman Mashayekhi - One of the best experts on this subject based on the ideXlab platform.
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photodynamic therapy for circumscribed Choroidal Hemangioma in 79 consecutive patients comparative analysis of factors predictive of visual outcome
Ophthalmology Retina, 2020Co-Authors: Maura Di Nicola, Jerry A Shields, Arman Mashayekhi, Basil K Williams, Archana Srinivasan, Saad Aldahmash, Carol L ShieldsAbstract:Purpose To determine factors predictive of visual outcome in patients with circumscribed Choroidal Hemangioma treated with photodynamic therapy (PDT). Design Retrospective case series. Participants Seventy-nine patients with circumscribed Choroidal Hemangioma treated with PDT. Methods Patients with circumscribed Choroidal Hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed. Main Outcome Measures Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse. Results Seventy-nine eyes of 79 patients with circumscribed Choroidal Hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0–10.0 mm); mean thickness was 3.0 mm (range, 1.4–4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0–7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P Conclusions In this comparative analysis, PDT was an effective treatment method for circumscribed Choroidal Hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.
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circumscribed Choroidal Hemangioma visual outcome in the pre photodynamic therapy era versus photodynamic therapy era in 458 cases
Ophthalmology Retina, 2020Co-Authors: Carol L Shields, Lauren A Dalvin, Lianne S Lim, Michael Chang, Sanika Udyaver, Mehdi Mazloumi, Pornpattana Vichitvejpaisal, Eleni Florakis, Arman Mashayekhi, Jerry A ShieldsAbstract:Purpose To analyze visual outcomes after treatment of Choroidal Hemangioma in the pre-photodynamic therapy (PDT) era versus PDT era. Design Retrospective, comparative case series. Participants A total of 458 patients with circumscribed Choroidal Hemangioma. Methods Comparison of Hemangioma managed in the pre-PDT (1967–2001) era versus PDT (2002–2018) era. Main Outcome Measure Visual acuity outcome. Results A total of 458 tumors were treated over this 51-year period. A comparison (pre-PDT [n = 220 cases] vs. PDT [n = 238 cases]) revealed PDT era patients were of older mean age (48.9 vs. 53.8 years, P = 0.002) and were more likely to have systemic hypertension (17.7% vs. 33.8%, P Conclusions Management of Choroidal Hemangioma in the PDT era has allowed for significantly better visual outcome compared with the pre-PDT era, with mean final visual acuity of 20/400 (pre-PDT era) versus 20/63 (PDT era).
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circumscribed Choroidal Hemangioma clinical features and outcomes by age category in 458 cases
Saudi Journal of Ophthalmology, 2019Co-Authors: Lauren A Dalvin, Lianne S Lim, Michael Chang, Sanika Udyaver, Mehdi Mazloumi, Pornpattana Vichitvejpaisal, Eleni Florakis, Arman Mashayekhi, Jerry A ShieldsAbstract:Abstract Purpose To investigate features and outcomes of circumscribed Choroidal Hemangioma by patient age. Methods Retrospective review of circumscribed Choroidal Hemangioma from 3/29/1967–6/4/2018 based on age at presentation (≤20 vs. >20–50 vs. >50 years). Results There were 458 circumscribed Choroidal Hemangiomas diagnosed at mean age (13 vs. 41 vs. 64 years, p Conclusion Younger patients (≤20 years) with circumscribed Choroidal Hemangioma present with worse visual acuity and larger, more posterior tumors. Future studies are needed to improve early detection and treatment for this subgroup of patients.
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resolution of advanced cystoid macular edema following photodynamic therapy for Choroidal Hemangioma
Ophthalmic Surgery Lasers & Imaging, 2005Co-Authors: Carol L Shields, Arman Mashayekhi, Miguel A Materin, Brian P Marr, Jerry A ShieldsAbstract:A 45-year-old man was referred for 2 months of decreasing vision in his left eye. His visual acuity was 20/200 secondary to a subtle juxtapapillary Choroidal Hemangioma producing profound cystoid macular edema, with the affected retina measuring 330 microns thick by optical coherence tomography. Due to the severe cystoid macular edema, visual prognosis was judged to be poor. One month following photodynamic therapy to the tumor using verteporfin, the cystoid macular edema completely resolved, foveal anatomy returned to normal, optical coherence tomography thickness was 179 microns, and visual acuity recovered to 20/25. Photodynamic therapy of Choroidal Hemangioma may be effective in resolving associated cystoid macular edema and improving visual acuity.
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circumscribed Choroidal Hemangioma
Current Opinion in Ophthalmology, 2003Co-Authors: Arman Mashayekhi, Carol L ShieldsAbstract:Circumscribed Choroidal Hemangioma is an uncommon, benign vascular tumor manifesting as an orange-red mass in the posterior pole of the eye. Serous retinal detachment accounts for decreased vision in most patients. Diagnosis of this tumor is challenging with many patients initially misdiagnosed with Choroidal melanoma or metastasis. Several ancillary tests such as ultrasonography, fluorescein angiography, indocyanine green angiography, and magnetic resonance imaging help differentiate this tumor from other simulating lesions. Asymptomatic lesions should be observed, but visually threatening or visually impairing lesions require treatment. Photodynamic therapy, laser photocoagulation, and transpupillary thermotherapy may be used for primary management of this tumor. Patients who fail to respond to previous treatment or those with extensive serous retinal detachment can be treated using radiotherapeutic modalities. Long interval between onset of symptoms and treatment, poor visual acuity at presentation, and presence of chronic retinal or retinal pigment epithelial changes are associated with poor long-term vision.
Hakan Demirci - One of the best experts on this subject based on the ideXlab platform.
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evaluation of Choroidal Hemangioma and treatment with photodynamic therapy by using enhanced depth imaging optical coherence tomography
Ophthalmic Surgery and Lasers, 2018Co-Authors: Zeynep Gursel Ozkurt, Naziha Slimani, Hakan DemirciAbstract:Background and objective To evaluate enhanced depth imaging optical coherence tomography (EDI-OCT) features of Choroidal Hemangioma and changes following photodynamic therapy (PDT). Patients and methods Retrospective review of 21 Choroidal Hemangiomas. Results On EDI-OCT, Choroidal Hemangioma showed low internal reflectivity in 47% of lesions and high internal reflectivity in 53%. The most common associated features were normal-looking honeycomb-like pattern in choriocapillaris in all lesions, inner segment/outer segment abnormality in 62%, photoreceptor outer segment abnormality in 62%, subretinal fluid with speckles in 62%, and shaggy photoreceptors in 57% of lesions. Internal reflectivity changed from low to high in 67% of lesions. Photoreceptor outer segment and plexiform layer abnormalities became more noticeable and shaggy photoreceptors improved. Conclusion On EDI-OCT, Choroidal Hemangioma showed normal-looking honeycomb-like pattern in the choriocapillaris, subretinal fluid with speckles, and abnormalities in the photoreceptor outer segment and plexiform layers. Following PDT, the choriocapillaris became sclerotic, and photoreceptor outer segment layer abnormalities were prominent. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:171-178.].
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Polypoidal Choroidal vasculopathy following photodynamic therapy for Choroidal Hemangioma.
European journal of ophthalmology, 2009Co-Authors: Samuray Tuncer, Carol L Shields, Hakan Demirci, Jerry A ShieldsAbstract:PURPOSE To report a case of circumscribed Choroidal Hemangioma (CCH) that responded to photodynamic therapy (PDT) but 3 years later developed polypoidal Choroidal vasculopathy (PCV) with exudative retinopathy. METHODS Case report. RESULTS A 59-year-old woman with a juxtapapillary CCH in her left eye was treated with a single 83-second, 7.5 mm PDT laser spot at 689 nm (50 J/cm2) 15 minutes after the injection of intravenous verteporfin (6 mg/m2). Three years later, the patient presented with photopsia in her left eye. Fundus examination of the left eye showed CCH regressed completely to a flat atrophic scar. There was diffuse macular edema and exudative retinopathy along the inferotemporal vascular arcade. On indocyanine green angiography, there were hyperfluorescent dilated Choroidal vessels inferior to the foveola with late staining and leakage consistent with PCV. Hypofluorescence superior and nasal to the optic disc at the site of the treated Hemangioma, consistent with Choroidal ischemia, was observed. She was treated with 1.25 mg (0.05 cc) intravitreal bevacizumab. After 21 months of follow-up, the exudative retinopathy and macular edema completely regressed. CONCLUSIONS PDT is an effective treatment for CCH. Side effects of PDT for CCH are rare but include PCV.
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circumscribed Choroidal Hemangioma clinical manifestations and factors predictive of visual outcome in 200 consecutive cases
Ophthalmology, 2001Co-Authors: Carol L Shields, Jerry A Shields, Santosh G Honavar, Jacqueline Cater, Hakan DemirciAbstract:Abstract Purpose To review the clinical features and management of circumscribed Choroidal Hemangioma and determine factors predictive of poor visual outcome. Design Retrospective consecutive noncomparative interventional case series. Participants Two hundred consecutive patients with circumscribed Choroidal Hemangioma. Main outcome measures The main outcome measures were analyzed in 155 patients with follow-up of at least 3 months and included complete resolution of subretinal fluid, worsening of visual acuity (more than 2 Snellen lines), and poor final visual acuity (20/200 or worse). Results The patients were seen at a mean age of 45 years with symptoms of decreased visual acuity (81%), visual field defect (7%), metamorphopsia (3%), floaters (2%), progressive hypermetropia (1%), photopsia (1%), pain (1%), and no symptoms (6%). The referring diagnoses were Choroidal Hemangioma (29%), Choroidal melanoma (29%), Choroidal metastasis (9%), retinal detachment (6%), central serous chorioretinopathy (5%), and others. The tumor had a median base of 6.0 mm and median thickness of 3.0 mm. Secondary retinal detachment in the foveal region was present in 81% of the patients. Initial treatment included observation (51%), laser photocoagulation (44%), plaque radiotherapy (4%), external beam radiotherapy (1%), surgical repair of retinal detachment (1%), and enucleation for painful neovascular glaucoma (1%). Kaplan-Meier estimates revealed complete resolution of subretinal fluid in 60% patients at 5 years and 76% patients at 10 years follow-up. By multivariable analysis, clinical factors predictive of complete resolution of subretinal fluid included shorter duration of symptoms ( P = 0.03) and inferior quadrant location of tumor ( P = 0.001). At initial presentation, 82 of 155 (53%) patients had poor visual acuity (20/200 or worse), and 73 of 155 (47%) patients had good to moderate visual acuity (20/100 or better). Of those 82 patients with poor initial vision, poor final vision was found in 54% at 5 years and 80% at 10 years. Of the 73 patients with good to moderate initial vision, poor final vision was found in 12% at 5 years and 43% at 10 years. By multivariable analysis, clinical factors predictive of poor final visual acuity included poor initial visual acuity ( P P = 0.01), and tumor management with observation after referral ( P = 0.02). Worsening of visual acuity (by more than 2 Snellen lines) was observed in 8% at 5 years and 28% at 10 years of those 82 patients who were initially seen with poor vision. Worsening of visual acuity was found in 10% at 5 years and 30% at 10 years of those 73 patients who initially were seen with good to moderate vision. Conclusions Circumscribed Choroidal Hemangioma is a rare intraocular tumor. In 38% of cases, this tumor is initially misinterpreted before referral as Choroidal melanoma or metastasis. Visual acuity is poor in more than 60% of patients at 10 years, despite successful control of associated subretinal fluid in 76% patients.