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Tsai TY, Chen KJ, Chao AN. Seven-year follow-up of a pediatric patient with combined hamartoma of retina and retinal pigment epithelium complicating with preretinal neovascularization and vitreous hemorrhage treated with intravitreal injections of bevacizumab. Taiwan J Ophthalmol 2023; 13:556-559. [PMID: 38249498 PMCID: PMC10798400 DOI: 10.4103/2211-5056.364566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022] Open
Abstract
We report a case of successful management of intravitreal injections of anti-vascular endothelial growth factor antibody bevacizumab in two unusual complications, preretinal neovascularization and vitreous hemorrhage, secondary to a combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). A male pediatric patient suffered from decreased vision in the right eye at 5-year-old. His ophthalmologic examination revealed a CHRRPE involving the superior area of the optic disc and macula in the right eye. The patient's family history and neurological examinations of tuberous sclerosis were absent. While no lesion growth was observed over time, preretinal vascularization and recurrent nonclearing hemorrhage occurred 2 years after the initial presentation. The patient was successfully managed with two intravitreal injections of bevacizumab. No recurrences of vitreous hemorrhage were observed at a 7-year post-treatment follow-up. Intravitreal injections of bevacizumab were safe and effective in the management of uncommon complications of preretinal neovascularization and vitreous hemorrhage of CHRRPE in a pediatric patient in long-term follow-up.
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Affiliation(s)
- Tsung-Ying Tsai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Rapid symptomatic and structural improvement of a retinal astrocytic hamartoma in response to anti-VEGF therapy: A case report. Am J Ophthalmol Case Rep 2022; 27:101606. [PMID: 35692434 PMCID: PMC9184888 DOI: 10.1016/j.ajoc.2022.101606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe a patient with bilateral peripapillary astrocytic hamartomas with exudation of subretinal fluid into the macula and loss of vision without evidence of choroidal neovascularization. The patient rapidly responded to intravitreal bevacizumab injections resulting in reduced subretinal fluid and clinical improvement. Observation A 70-year-old female presented with worsening vision in her left eye due to subretinal fluid exudation from a peripapillary astrocytic hamartoma. The patient was treated with two doses of bevacizumab with rapid improvement in vision and resolution of subretinal fluid. Genetic testing was negative for common pathogenic variants for tuberous sclerosis and neurofibromatosis, which are highly associated with bilateral optic nerve and retinal astrocytic hamartomas. Conclusion Astrocytic hamartomas with exudation may be responsive to bevacizumab suggesting a dependence of these lesions on vascular endothelial growth factor (VEGF) independent of secondary choroidal neovascularization. Furthermore, this case describes a patient with bilateral astrocytic hamartomas without genetic or clinical confirmation of associated phakomatoses, such as tuberous sclerosis and neurofibromatosis. Bilateral retinal astrocytic hamartomas (RAH) may become symptomatic in adulthood. FA and OCT are important diagnostic tests when evaluating symptomatic RAH. RAH can generate subretinal fluid independent of choroidal neovascularization. RAH-associated subretinal fluid may respond to anti-VEGF therapy.
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Shrestha RM, Bhatt S, Shrestha P, Sapkota P, Keshari R, Manandhar A, Bhattarai I. Rhegmatogenous Retinal Detachment with Spontaneous Dialysis of the Ora Serrata in Neurofibromatosis Type 1: A Case Report. JNMA J Nepal Med Assoc 2022; 60:555-558. [PMID: 35690984 PMCID: PMC9275462 DOI: 10.31729/jnma.7392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/30/2022] [Indexed: 11/01/2022] Open
Abstract
Neurofibromatosis type 1 is a genetic disorder that follows an autosomal dominant pattern of inheritance. Ocular involvement is not uncommon, but spontaneous dialysis of the retina in the absence of a history of trauma is a rare clinical entity. Rare cases of retinal involvement such as retinal detachment or dialysis of ora serrata could be linked with the abnormal cell-matrix formation in neurofibromatosis type 1. Here, we present a case of a 36-year-old man having Neurofibromatosis Type 1 with spontaneous dialysis of ora serrata without prior history of ocular trauma. A routine fundoscopic examination should be done in addition to the examination of the anterior chamber in patients with neurofibromatosis type 1 despite the absence of ocular complaints. Keywords case reports; neurfibromatosis type 1; ora serrata; retinal; retinal detachment.
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Affiliation(s)
- Richa Makaju Shrestha
- Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal,Correspondence: Dr Richa Makaju Shrestha, Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal. , Phone: +977-9851184710
| | - Swechha Bhatt
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Pooja Shrestha
- Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Prakash Sapkota
- Department of Internal Medicine, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Rajani Keshari
- Department of Ophthalmology, Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Anu Manandhar
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| | - Iwa Bhattarai
- Kathmandu University School of Medical Sciences, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
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Amoroso F, Souied EH, Bruyère E, Astroz P, Mouallem-Beziere A, Pedinielli A, Miere A. TWO-YEAR FOLLOW-UP OF A RETINAL ASTROCYTIC HAMARTOMA IMAGED BY OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retin Cases Brief Rep 2022; 16:338-343. [PMID: 32004181 DOI: 10.1097/icb.0000000000000975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To report a case of retinal astrocytic hamartoma imaged by optical coherence tomography angiography (OCTA), followed for 2 years. METHODS Observational case report. RESULTS A 25-year-old woman was referred for an incidental retinal lesion in the left eye (LE). At baseline, the best-corrected visual acuity in the LE was 20/32, and fundus examination showed the presence of a round, pigmented lesion in juxtafoveal region, corresponding, on spectral domain OCT, to a hyperreflective lesion within nerve fiber layer. Optical coherence tomography angiography revealed the presence of a high-flow lesion in the superficial capillary plexus segmentation. The patient was followed up for 2 years: best-corrected visual acuity remained stable and multimodal imaging, including OCTA, confirmed the benign and stable nature of the lesion. At baseline, the total lesion area on OCTA (superficial capillary plexus) was 0.181 mm2, whereas vascular density was 52.080%; the total area was 0.204 mm2, and vascular density was 53.740% at 2-year follow-up. CONCLUSION Optical coherence tomography angiography is helpful not only for the diagnosis and follow-up of such rare tumors, but also it gives insights as to how these tumors develop and how they affect surrounding structures.
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Affiliation(s)
- Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil University Paris Est Créteil, Créteil, France
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Emmanouil B, Wasik M, Charbel Issa P, Halliday D, Parry A, Sharma SM. Structural Abnormalities of the Central Retina in Neurofibromatosis Type 2. Ophthalmic Res 2022; 65:77-85. [PMID: 34673638 DOI: 10.1159/000519143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 08/13/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This case-control study seeks to systematically characterize the central retinal findings in a large cohort of patients with neurofibromatosis type 2 (NF2) using spectral domain optical coherence tomography (SD-OCT) as well as the examination of the potential use of this technique as a diagnostic tool in NF2. METHODS Fifty-four patients with an NF2 diagnosis seen in a quaternary national service were age- and gender-matched to 55 controls from the normal population. Two masked assessors categorized SD-OCT images using predefined abnormalities: retinal tufts, epiretinal membrane (ERM) appearance, retinal hamartoma, and foveal contour. Specificity, sensitivity, and positive and negative predictive values were calculated for each retinal abnormality. Trends of retinal abnormalities with NF2 genetic severity groups (1. tissue mosaic; 2A. mild classic; 2B. moderate classic; and 3. severe) were investigated. RESULTS We found retinal abnormalities in 26 patients with NF2 (48%) and 2 control patients (4%); retinal tufts were the most common abnormality therein (43%) and were not seen in controls. The specificity and sensitivity of the graded abnormalities on OCT scans in NF2 were 96% and 48%, respectively, with a positive predictive value of 93%. In our cohort, retinal tufts had a specificity of 100%, a sensitivity of 43%, and a positive predictive value of 100%. Retinal hamartomas were seen only in NF2 patients (35% sensitivity and 100% specificity). ERMs had 96% specificity and 13% sensitivity. The proportion of patients with retinal abnormalities increased statistically significantly with NF2 genetic severity; all patients within the 3. severe genetic severity had an abnormal SD-OCT. DISCUSSION/CONCLUSION We present a systematic study of central retinal abnormalities in an NF2 population as seen on SD-OCT imaging. Our results show a high frequency of retinal abnormalities that are readily detected by SD-OCT imaging. The presence of retinal tufts may be a novel marker of NF2 with both high specificity and a positive predictive value for NF2, compared to other well-known ocular features of NF2, and may have a place in the NF2 diagnostic criteria.
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Affiliation(s)
- Beatrice Emmanouil
- Neurofibromatosis Type 2 Unit, Department of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Oxford, United Kingdom
| | - Martin Wasik
- Neurofibromatosis Type 2 Unit, Department of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Dorothy Halliday
- Neurofibromatosis Type 2 Unit, Department of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Allyson Parry
- Neurofibromatosis Type 2 Unit, Department of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Srilakshmi M Sharma
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Touzé R, Abitbol MM, Bremond-Gignac D, Robert MP. RETINAL VASCULAR ABNORMALITIES IN CHILDREN WITH NEUROFIBROMATOSIS TYPE 1. Retina 2021; 41:2589-2595. [PMID: 34111884 DOI: 10.1097/iae.0000000000003234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE Retinal vascular abnormalities (RVAs) have been recently described in patients with neurofibromatosis Type 1 (NF1) as vascular tortuosity, best visible on infrared imaging. This study assessed clinical RVA's characteristics in a large series of children with NF1. METHODS This retrospective observational study was conducted in children (0-18 years) with an NF1 diagnosis. Using near-infrared imaging, RVAs were classified according to the nature of vessels involvement and their degree of tortuosity. RESULTS Retinal imaging from 140 children, with a median age of 8.8 years (1.5-18), was included; 52 patients (37.1%) (81 eyes) exhibited RVAs. These RVAs comprised 96% (50/52) of simple vascular tortuosity and 17% (9/52) of a corkscrew pattern. A corkscrew pattern involved only small veins, whereas simple vascular tortuosity could affect both arteries and veins. No statistically significant age correlation was observed, but evolution of RVAs from simple vascular tortuosity to corkscrew pattern was observed in 5 cases. CONCLUSION Retinal vascular abnormalities occurred in 37.1% of children with NF1. These abnormalities may result from NF1 promoting localized tortuosity in both small arteries and veins, whereas only small second-order or tertiary-order venules evolve to a highly tortuous pattern.
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Affiliation(s)
- Romain Touzé
- Ophthalmology Department, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Marc M Abitbol
- Ophthalmology Department, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- INSERM, UMRS 1138, Team 17, from Physiopathology of Ocular Diseases to Clinical Development, Paris University, Paris, France; and
| | - Dominique Bremond-Gignac
- Ophthalmology Department, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- INSERM, UMRS 1138, Team 17, from Physiopathology of Ocular Diseases to Clinical Development, Paris University, Paris, France; and
| | - Matthieu P Robert
- Ophthalmology Department, Hôpital Universitaire Necker-Enfants Malades, Paris, France
- Borelli Centre, UMR 9010, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
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Abdolrahimzadeh S, Formisano M, Scuderi L, Rahimi S. Long-term follow-up of adult patient with neurofibromatosis type 1 with retinal astrocytic hamartoma using spectral-domain optical coherence tomography: a review of the literature and a report of a case. Ophthalmic Genet 2020; 42:209-215. [PMID: 33203322 DOI: 10.1080/13816810.2020.1849315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Background: Retinal astrocytic hamartoma (RAH) is a tumor that can be sporadic or in the context of tuberous sclerosis complex (TSC) and has been reported to be associated with neurofibromatosis type 1 (NF1) in a few cases.Patient and methods: A 65-year-old male patient with NF1 was referred for ophthalmological evaluation. Comprehensive examination, near-infrared reflectance (NIR), spectral-domain optical coherence tomography (SDOCT), fluorescein angiography (FFA), and indocyanine green angiography (ICGA) were carried out. The follow-up of the patient was at 4 and 7 years.Results: Best-corrected visual acuity (BCVA) was 20/20 in both eyes. Anterior segment examination revealed bilateral Lisch nodules. Fundus examination was unremarkable but at NIR and SDOCT the patient presented choroidal hamartoma, microvascular retinal alterations, and enlarged choroidal vessels in both eyes. NIR also revealed an unusual area of peripapillary hyporeflectivity in the right eye. On SDOCT, this corresponded to an elevated peripapillary mass characterized by intralesional optically empty cavities in the retinal nerve fiber layer (RNFL) and ganglion cell layer-inner plexiform layer (GCL-IPL), diagnosed as a RAH. Four years later, BCVA was 20/25 with a retinal schisis departing from the lesion to the macula. At 7 years, BCVA was stable at 20/25, the lesion was smaller, and there was a slight reduction of the schisis.Conclusion: RAH is a rare finding in NF1 and the translucent type has not been previously reported. RAH in NF1 has a peripapillary location and demonstrates clinically unpredictable behavior; thus, close monitoring with multimodal imaging is advisable.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, NESMOS Department, University of Rome Sapienza, St.Andrea Hospital, Rome, Italy
| | - Martina Formisano
- Ophthalmology Unit, Department of Sense Organs, University of Rome Sapienza, Azienda Policlinico Umberto I, Rome, Italy
| | - Luca Scuderi
- Ophthalmology Unit, Department of Sense Organs, University of Rome Sapienza, Azienda Policlinico Umberto I, Rome, Italy
| | - Siavash Rahimi
- Histopathology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.,School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Kilgore DA, Sanders R, Uwaydat S. Novel and Unusual Retinal Findings in Two Patients with Neurofibromatosis Type 1. Case Rep Ophthalmol 2020; 11:588-594. [PMID: 33437232 PMCID: PMC7747081 DOI: 10.1159/000510013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/08/2020] [Indexed: 12/03/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a phacomatosis known to be associated with several developmental abnormalities in multiple organ systems including the eyes. NF1 can present with varying ophthalmic manifestations, including Lisch nodules, retinal astrocytic hamartomas, capillary hemangiomas, plexiform neurofibromas, and choroidal nodules. We present 2 cases of NF1 with presentations that may represent underreported retinal abnormalities occurring in NF1. Case 1 presents a patient who developed spontaneous peripheral retinal dialysis with subsequent retinal detachment; case 2 discusses a patient with multiple pigmented choroidal lesions bilaterally.
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Affiliation(s)
| | | | - Sami Uwaydat
- *Sami Uwaydat, MD, Jones Eye Institute, Department of Ophthalmology, University of Arkansas for Medical Sciences, 4301 West Markham St., Slot 523, Little Rock, AR 72205 (USA),
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Retinal manifestations of the neurocutaneous disorders. Curr Opin Ophthalmol 2020; 31:549-562. [PMID: 33009088 DOI: 10.1097/icu.0000000000000712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The neurocutaneous disorders are a genetically and phenotypically diverse group of congenital syndromes characterized by cutaneous, ocular, and central nervous system manifestations. This review provides an overview of the clinical features and retinal findings in selected neurocutaneous disorders. RECENT FINDINGS Advances in genetics and diagnostic retinal and neuroimaging allow for the recognition of retinal features of common neurocutaneous syndromes and for improved characterization of rarer entities based on previously underdiagnosed or unrecognized retinal findings. SUMMARY Better characterization of the neurocutaneous disorders allows for earlier recognition and the potential for expeditious vision-saving and life-saving treatment.
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Das A, Ghosh P, Zameer L, Ramprasad VL, Bhaduri A. Simultaneous diagnosis of unilateral retinoblastoma and contralateral optic pathway glioma in a child with neurofibromatosis type 1. Pediatr Hematol Oncol 2019; 36:82-85. [PMID: 30963792 DOI: 10.1080/08880018.2019.1591550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Anirban Das
- a Department of Pediatric Hematology/Oncology , Tata Medical Center , Kolkata , India
| | - Priya Ghosh
- b Department of Radiology , Tata Medical Center , Kolkata , India
| | - Lateef Zameer
- c Department of Histopathology , Tata Medical Center , Kolkata , India
| | | | - Anirban Bhaduri
- e Department of Ophthalmology , The Calcutta Medical Research Institute , Kolkata , India
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Thavikulwat AT, Edward DP, AlDarrab A, Vajaranant TS. Pathophysiology and management of glaucoma associated with phakomatoses. J Neurosci Res 2018; 97:57-69. [DOI: 10.1002/jnr.24241] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/10/2018] [Accepted: 03/12/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Alisa T. Thavikulwat
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
| | - Deepak P. Edward
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
| | - Abdulrahman AlDarrab
- King Khaled Eye Specialist Hospital; Riyadh Saudi Arabia
- Department of Surgery, College of Medicine; Prince Sattam Bin Abdulaziz University; Alkharj Saudi Arabia
| | - Thasarat S. Vajaranant
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences; University of Illinois at Chicago; Chicago Illinois
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Kinori M, Hodgson N, Zeid JL. Ophthalmic manifestations in neurofibromatosis type 1. Surv Ophthalmol 2017; 63:518-533. [PMID: 29080631 DOI: 10.1016/j.survophthal.2017.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
Neurofibromatosis type 1 (NF1) is a relatively common multisystemic inherited disease and has been extensively studied by multiple disciplines. Although genetic testing and confirmation are available, NF1 remains a clinical diagnosis. Many manifestations of NF1 involve the eye and orbit, and the ophthalmologist, therefore, plays a significant role in the diagnosis and treatment of NF1 patients. Improvements in diagnostic and imaging instruments have provided new insight to study the ophthalmic manifestations of the disease. We provide a comprehensive and up-to-date overview of the ocular and orbital manifestations of NF1.
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Affiliation(s)
- Michael Kinori
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nickisa Hodgson
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, California, USA
| | - Janice Lasky Zeid
- Department of Ophthalmology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
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Tucci A, Saletti V, Menni F, Cesaretti C, Scuvera G, Esposito S, Melloni G, Esposito S, Milani D, Cereda C, Cigada M, Tresoldi L, Viola F, Natacci F. The absence that makes the difference: choroidal abnormalities in Legius syndrome. J Hum Genet 2017; 62:1001-1004. [DOI: 10.1038/jhg.2017.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/19/2017] [Accepted: 06/19/2017] [Indexed: 01/20/2023]
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Nourinia R, Motevasseli T, Tofighi Z. Intravitreal bevacizumab role in the treatment of macular edema secondary to retinal vasoproliferative tumor in a patient with neurofibromatosis type 1. GMS OPHTHALMOLOGY CASES 2016; 6:Doc08. [PMID: 27703870 PMCID: PMC5039346 DOI: 10.3205/oc000045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: To report a case of neurofibromatosis-1 (NF-1) with retinal vasoproliferative tumor (RVPT) and macular edema and exudation that was successfully treated with intravitreal bevacizumab (IVB). Method: A retrospective case report of patient with neurofibromatosis, retinal vasoproliferative tumor and macular edema who received three monthly intravitreal injections of bevacizumab. Optical coherence tomography (OCT) and fluorescein angiography (FAG) before and three months after treatment were done. Results: Macular edema and exudation of the right eye was effectively resolved with IVB injection and vascularity of RVPT significantly decreased after treatment with IVB. Conclusion: Macular edema and exudation secondary to RVPT in patients with NF-1 could be successfully treated with IVB.
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Affiliation(s)
- Ramin Nourinia
- Ophthalmic research center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Tahmineh Motevasseli
- Ophthalmic research center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Zahra Tofighi
- Ophthalmic research center, Shahid Beheshti University of Medical Science, Tehran, Iran
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15
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An Update on the Ophthalmologic Features in the Phakomatoses. J Ophthalmol 2016; 2016:3043026. [PMID: 27493794 PMCID: PMC4967465 DOI: 10.1155/2016/3043026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/11/2016] [Accepted: 06/06/2016] [Indexed: 11/18/2022] Open
Abstract
Neurofibromatosis type 1, tuberous sclerosis complex, and Von Hippel-Lindau disease, historically classified as the phakomatoses, are hereditary multisystem disorders characterized by the presence of hamartoma, which carry the risk of malignant transformation. The alteration of tumor suppressor genes seems to be at the basis of their pathophysiogenetic mechanism. Lisch and choroidal nodules in neurofibromatosis type 1, retinal astrocytomas in tuberous sclerosis complex, and retinal capillary hemangioma in Von Hippel-Lindau disease are the principal ophthalmic hamartomatous manifestations. The advent of novel imaging techniques such as near infrared reflectance and optical coherence tomography has provided unprecedented insight on the choroidal and retinal features of these diseases. These methods have improved early diagnosis and the ongoing surveillance in these conditions. Among an array of treatment modalities, antivascular endothelial growth factor therapy has been used in the management of retinal hamartomas but results have been varied. This review is an update on the pathophysiogenetic mechanisms, ophthalmic manifestations, and novel treatment strategies in the phakomatoses with emphasis on the role of imaging techniques.
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Abdolrahimzadeh B, Piraino DC, Albanese G, Cruciani F, Rahimi S. Neurofibromatosis: an update of ophthalmic characteristics and applications of optical coherence tomography. Clin Ophthalmol 2016; 10:851-60. [PMID: 27257370 PMCID: PMC4874640 DOI: 10.2147/opth.s102830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Neurofibromatosis (NF) is a multisystem disorder and tumor predisposition syndrome caused by genetic mutation on chromosome 17-17q11.2 in NF type 1 (NF1), and on chromosome 22-22q12.2 in NF type 2. The disorder is characterized by considerable heterogeneity of clinical expression. NF1 is the form with the most characteristic ocular manifestations. Lisch nodules of the iris are among the well-known diagnostic criteria for the disease. Glaucoma and associated globe enlargement have been described in a significant proportion of patients with NF1 and orbital–facial involvement. Optic nerve glioma may cause strabismus and proptosis, and palpebral neurofibroma may reach considerable size and occasionally show malignant transformation. Near infrared reflectance has greatly contributed to enhancing our knowledge on choroidal alterations in NF1. Indeed, some authors have proposed to include these among the diagnostic criteria. Optical coherence tomography has given new insight on retinal alterations and is a noninvasive tool in the management of optic nerve gliomas in children. Ocular manifestations in NF type 2 can range from early-onset cataracts in up to 80% of cases to optic nerve hamartomas and combined pigment epithelial and retinal hamartomas.
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Affiliation(s)
| | - Domenica Carmen Piraino
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Giorgio Albanese
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Filippo Cruciani
- Section of Ophthalmology, Department of Sense Organs, University of Rome "Sapienza", Rome, Italy
| | - Siavash Rahimi
- Pathology Centre, Queen Alexandra Hospital, Portsmouth, UK
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Seth A, Ghosh B, Gupta A, Goel N. Peripheral retinal ischemia in a young Indian woman with neurofibromatosis type 1. Saudi J Ophthalmol 2016; 30:60-3. [PMID: 26949362 PMCID: PMC4759519 DOI: 10.1016/j.sjopt.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/20/2015] [Accepted: 08/31/2015] [Indexed: 12/02/2022] Open
Abstract
Neurofibromatosis type 1 (NF-1) is an autosomal dominantly inherited disease characterized by café-au-lait spots, neurofibromas, axillary freckling, Lisch nodules of iris, gliomas and various systemic vascular ischemic manifestations mainly in the aorta, brain and kidney. Retinal vascular manifestations in patients with NF-1 are usually representative of retinal capillary hemangiomatosis. Few cases of NF-1 with retinal vascular occlusive disease have been described. We describe a young Indian woman with NF-1 with unilateral peripheral retinal ischemia but no vascular abnormality at the posterior pole.
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Affiliation(s)
- Anisha Seth
- Corresponding author at: BN-56, East Shalimar Bagh, New Delhi 110088, India. Tel.: +91 9968355495.BN-56East Shalimar BaghNew Delhi110088India
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Abstract
PURPOSE To describe an unusual limbal lesion clinically resembling pterygium in a young patient with neurofibromatosis type 1. METHODS Clinical case report with a review of the literature. RESULTS The lesion was excised, and histopathology was performed. Histopathology disclosed conjunctival mucosa with expansion of the substantia propria by dense and loose collagenous tissue, small nerves, and thin-walled blood vessels. No skin or skin appendages were seen, although a small amount of mature adipose was present. Focally, spindle cells with wavy nuclei were seen scattered within the collagenous areas and were positive on S100 immunohistochemistry. Mast cells were readily identifiable. There was no evidence of actinic elastosis, dysplasia, or malignancy. These histopathological features most resemble heterotopia with some features of neurofibroma. CONCLUSIONS We report an unusual limbal lesion in a patient with neurofibromatosis type 1. Histopathological features resemble a heterotopia with some neurofibroma features. We suggest that all lesions excised from patients with neurofibromatosis, no matter how characteristic in appearance, be sent for histopathological confirmation of diagnosis.
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Abstract
PURPOSE To describe a patient with severe ischemic retinopathy and maculopathy in the context of neurofibromatosis Type 1. METHODS Case report illustrated with multimodal clinical imaging. A 16-year-old female with neurofibromatosis Type 1 presented with visual deterioration over several weeks. Her right eye was amblyopic because of an optic nerve glioma treated in childhood with chemotherapy. RESULTS Corrected visual acuities were counting fingers in the right eye and 20/150 in the left eye. Examination revealed bilateral optic disk pallor. In the left eye, severe and extensive ischemic retinopathy and maculopathy were noted with collateral formation and neovascularization. Proximal arterial occlusion at the level of the internal carotid and ophthalmic arteries was excluded on neuroimaging, including computed tomography angiography. CONCLUSION Neurofibromatosis Type 1 may present in the ocular fundus with a variety of lesion types, including vasoproliferative tumors, hamartoma, uveal melanoma, and hemangioma. Vascular occlusions are relatively uncommon. Ocular ischemic syndrome secondary to moyamoya syndrome is well described in neurofibromatosis Type 1 but was excluded in our patient. A spectrum of retinal microvascular abnormalities has also been described, but disease-specific evidence to guide treatment is lacking.
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20
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Multifocal retinal astrocytic hamartomas: a case series and review of the literature. Retin Cases Brief Rep 2015; 7:9-13. [PMID: 25390511 DOI: 10.1097/icb.0b013e318271ee7f] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Retinal astrocytic hamartoma is a benign glial tumor found in the nerve fiber layer, and it is most commonly reported as a solitary lesion. Multiple or bilateral lesions may be indicative of systemic disease, such as tuberous sclerosis complex or neurofibromatosis 1. We present three unique cases of multifocal and bilateral retinal astrocytic hamartomas in patients with suspected tuberous sclerosis complex. The typical features, diagnosis, management, and systemic implications of these retinal lesions are discussed. METHODS Consecutive case series at a university-based ophthalmology clinic. RESULTS The age of the patients ranged from 9 years to 27 years. The patients came from different ethnic backgrounds and had no known family history of tuberous sclerosis complex or neurofibromatosis. Two of the three patients had asthma, along with brain and kidney tumors. Two of the three patients had a seizure disorder, and one of the three patients had mental retardation. Only one patient presented with an ocular complaint of decreased vision, as a result of a presumed unrelated process. All patients had bilateral and multifocal astrocytic hamartomas. CONCLUSION Multifocal retinal astrocytic hamartomas are unique and can be the first manifestation of a systemic disease such as tuberous sclerosis complex or neurofibromatosis 1. Prompt referral for imaging and workup with the appropriate medical subspecialty can help prevent or delay the morbidity related to these systemic conditions.
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21
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Abdolrahimzadeh S, Felli L, Piraino DC, Mollo R, Calvieri S, Recupero SM. Retinal microvascular abnormalities overlying choroidal nodules in neurofibromatosis type 1. BMC Ophthalmol 2014; 14:146. [PMID: 25424184 PMCID: PMC4258815 DOI: 10.1186/1471-2415-14-146] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 11/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder involving aberrant proliferation of multiple tissues of neural crest origin. Retinal vascular alterations in NF1 have rarely been reported in the literature and their nature is not clear. This study describes distinctive retinal microvascular alterations and their relationship to choroidal nodules in patients with neurofibromatosis type 1. METHODS This was a retrospective study where records of seventeen consecutive patients with diagnosis of NF1, presenting Lisch nodules and choroidal alterations, and 17 age and gender-matched healthy control patients were evaluated. Fundus photographs, near infrared reflectance and enhanced depth imaging - optical coherence tomography images were reviewed. Retinal microvascular abnormalities and choroidal and retinal alterations in proximity of the retinal microvacular alterations were carefully noted. RESULTS 6 patients (35%) presented distinctive microvascular abnormalities. These consisted of small, tortuous vessels with a "spiral" or "corckscrew" aspect. They were second or third order, small tributaries of the superior or inferior temporal vein. These vessels were all located overlying choroidal alterations as observed with near infrared reflectance. Enhanced depth imaging - optical coherence tomography showed alteration of choroidal vasculature due to the presence of choroidal nodules but otherwise retinal and choroidal cross-sections were unremarkable for morphology. CONCLUSIONS Retinal microvascular alterations overlying choroidal nodules in patients with NF1 can be considered another distinctive characteristic of the disease. Although the nature of these alterations is not clear, the authors speculate that functional disorders of vasomotor nerve cells, which originate in the embryonal neural crest can lead to their formation.
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Affiliation(s)
- Solmaz Abdolrahimzadeh
- Ophthalmology Unit, DAI Testa/Collo, Azienda Policlinico Umberto I, University of Rome "Sapienza", viale del Policlinico 155, Rome, Italy.
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22
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Iris neovascularization and neovascular glaucoma in neurofibromatosis type 1: report of 3 cases in children. J Glaucoma 2013; 22:336-41. [PMID: 22138687 DOI: 10.1097/ijg.0b013e318239c35d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To report the clinical findings and outcomes in 3 patients with neurofibromatosis 1 (NF1) and retinal vascular abnormalities that resulted in angle closure secondary to iris neovascularization and describe the histopathologic abnormalities in 1 case. PATIENTS AND METHODS Retrospective case series of patients with NF1 and angle closure due to iris neovascularization secondary to retinal vascular abnormalities. Histopathologic analysis of an enucleated eye in 1 case. RESULTS Three children whose age ranged from 5 to 10 years at presentation, developed unilateral retinal vascular abnormalities that resulted in iris neovascularization and angle closure with a wide range of intraocular pressures. Two patients had retinal vasoproliferative lesions of which the affected eye became blind in 1 patient and the other retained useful vision after treatment with intracameral Bevacizumab, ablation of the retinal lesions, and surgical treatment of the neovascular glaucoma. The third patient underwent enucleation and had pathologic evidence of retinal ischemia. CONCLUSIONS A variety of retinal vascular lesions occurring in NF1 are capable of producing iris neovascularization, ectropion uvea, and neovascular glaucoma. Although a spectrum of serious complications resulting in total vision loss can occur, retention of useful vision is possible, in some cases, with aggressive treatment of the retinal lesions and associated neovascular glaucoma. This report highlights the need for careful examination of the posterior segment with special attention to peripheral retinal vascular abnormalities or tumors in young patients with NF1.
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Pichi F, Morara M, Lembo A, Ciardella AP, Meduri A, Nucci P. Neovascular glaucoma induced by peripheral retinal ischemia in neurofibromatosis type 1: management and imaging features. Case Rep Ophthalmol 2013; 4:69-73. [PMID: 23687499 PMCID: PMC3656684 DOI: 10.1159/000350956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Purpose To report the case of a young patient affected by neurofibromatosis 1 (NF-1) with peripheral retinal ischemia-induced neovascular glaucoma and the peculiar spectral-domain optical coherence tomography (SD-OCT) features. Material and Methods A 13-year-old boy affected by NF-1, as diagnosed according to established criteria, was referred with a diagnosis of hypertensive uveitis in his left eye. He underwent a complete ophthalmic examination and comprehensive blood work with viral and immunological tests. The case was documented with fluorescein angiography (FA) and SD-OCT. When the intraocular pressure (IOP) of the left eye decreased and the cornea cleared, FA revealed retinal ischemia and leakage from pathologic retinal vessels. SD-OCT revealed foveal hypoplasia secondary to the complete absence of the retinal nerve fiber layer. Results Peripheral retinal ischemia-induced neovascular glaucoma was diagnosed. The patient underwent Ahmed valve implantation to control his IOP, and subsequent retinal photocoagulation by argon laser and intravitreal bevacizumab injection were performed to control neovascularization. Discussion Retinal ischemia in NF-1 might lead to neovascular glaucoma: lowering of the IOP with surgical implantation of an Ahmed valve, regression of neovascularization by argon laser panretinal photocoagulation and intravitreal injection of bevacizumab can be a helpful way to control such a complication.
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Affiliation(s)
- Francesco Pichi
- University Eye Clinic, San Giuseppe Hospital, Milan, Messina, Italy
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25
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Byun YS, Park YH. Indocyanine green angiographic findings of obscure choroidal abnormalities in neurofibromatosis. KOREAN JOURNAL OF OPHTHALMOLOGY 2012; 26:230-4. [PMID: 22670083 PMCID: PMC3364438 DOI: 10.3341/kjo.2012.26.3.230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 10/11/2010] [Indexed: 11/23/2022] Open
Abstract
We report two cases of choroidal neurofibromatosis, detected with the aid of indocyanine green angiography (ICGA) in patients with neurofibromatosis (NF)-1, otherwise having obscure findings based on ophthalmoscopy and fluoresceine angiography (FA). In case 1, the ophthalmoscopic exam showed diffuse bright or yellowish patched areas with irregular and blunt borders at the posterior pole. The FA showed multiple hyperfluorescent areas at the posterior pole in the early phase, which then showed more hyperfluorescence without leakage or extent in the late phase. The ICGA showed diffuse hypofluorescent areas in both the early and late phases, and the deep choroidal vessels were also visible. In case 2, the fundus showed no abnormal findings, and the FA showed weakly hypofluorescent areas with indefinite borders in both eyes. With the ICGA, these areas were more hypofluorescent and had clear borders. Choroidal involvement in NF-1 seems to occur more than expected. In selected cases, ICGA is a useful tool to be utilized when an ocular examination is conducted in a patient that has no definite findings based on the ophthalmoscope, B-scan, or FA tests.
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Affiliation(s)
- Yong Soo Byun
- Department of Ophthalmology and Visual Science, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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26
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Yassin SA, Al-Tamimi ER. Familial bilateral combined hamartoma of retina and retinal pigment epithelium associated with neurofibromatosis 1. Saudi J Ophthalmol 2012; 26:229-34. [PMID: 23960997 DOI: 10.1016/j.sjopt.2012.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 02/27/2012] [Accepted: 03/12/2012] [Indexed: 01/06/2023] Open
Abstract
We report a family of three siblings followed between 2005 and 2011 with bilateral combined hamartoma of the retina and retinal pigment epithelium, with the age of diagnosis ranging from 7 to 13 years. The main reason for consultation was reduction of vision and squint. The diagnosis was determined based on the clinical findings on fundus examination: increased pigmentation at the macula with slightly elevated, gray-white macular lesion, tortuosity of perimacular blood vessels and glial epiretinal membrane. The elder brother was found to have left posterior subcapsular cataract. He was also confirmed to have neurofibromatosis type 1, the youngest sister fit in the diagnostic criteria for neurofibromatosis type 1, while the middle sister was presumed to have neurofibromatosis type 1. Follow-up showed stability of the retinal lesion in the three cases, with the progression to develop right posterior subcapsular cataract in the elder sister. This report is aimed to demonstrate that the occurrence of bilateral combined hamartoma of the retina and retinal pigment epithelium could raise the possibility of associated neurofibromatosis.
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Affiliation(s)
- Sanaa A Yassin
- Department of Ophthalmology, King Fahd Hospital of the University, University of Dammam, Saudi Arabia
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27
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Affiliation(s)
- Sara J Haug
- Department of Ophthalmology, University of California, San Francisco, 10 Koret Way, Room K301, San Francisco, CA 94143, USA
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28
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Ocular features in Egyptian genetically disabled children. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2011. [DOI: 10.1016/j.ejmhg.2011.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Elgi U, Berker N, Teke MY, Simsek T, Ozdal P. Unusual association of peripheral retinal ischemia-induced neovascular glaucoma and neurofibromatosis type 1. J Pediatr Ophthalmol Strabismus 2010; 47 Online:e1-3. [PMID: 21214163 DOI: 10.3928/01913913-20100324-02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 01/22/2009] [Indexed: 11/20/2022]
Abstract
A 12-year-old girl with neurofibromatosis type 1 was referred for pain and blurred vision in her right eye for the past 2 weeks. Neovascular glaucoma associated with peripheral retinal ischemia was diagnosed and she was treated with retinal photocoagulation after intravitreal bevacizumab injection and trabeculectomy.
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Affiliation(s)
- Ufuk Elgi
- Ulucanlar Eye Research Hospital, Ankara, Turkey
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30
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Lee YH, Kim KN, Shin KS, Kim JY. Hemi-central Retinal Vein Occlusion in a Patient With Neurofibromatosis 1. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.1.150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yeon Hee Lee
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
| | - Kyoung Nam Kim
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Kyoung Sup Shin
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jung Yeul Kim
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
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31
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Venkatesh P, Verma L, Tewari HK. Retinal vasculopathy in autosomal dominant neurofibromatosis type 1. Neuroophthalmology 2009. [DOI: 10.1076/noph.26.4.223.15864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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32
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Mustonen E, Poyhonen M, Leisti EL. Neuro-ophthalmological findings in neurofibromatosis: Clinical and neuroradiological study of 125 patients. Neuroophthalmology 2009. [DOI: 10.3109/01658109709044655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Eliott D, Schachat AP. Combined Hamartoma of the Retina and Retinal Pigment Epithelium. Semin Ophthalmol 2009. [DOI: 10.3109/08820539309060246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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34
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Hood CT, Janku L, Lowder CY, Singh AD. Retinal Vasoproliferative Tumor in Association with Neurofibromatosis Type 1. J Pediatr Ophthalmol Strabismus 2009. [PMID: 19645388 DOI: 10.3928/01913913-20090616-05] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Accepted: 09/24/2008] [Indexed: 11/20/2022]
Abstract
Retinal vasoproliferative tumor is an uncommon benign vascular tumor that most often occurs sporadically. Vision loss can occur secondary to retinal fibrosis, subretinal exudation, and neovascular glaucoma. This report describes a functionally monocular patient with neurofibromatosis type 1 who had a vasoproliferative tumor with neovascularization of the iris that was successfully treated with intravitreal bevacizumab and cryotherapy.
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35
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Augsburger JJ, Bolling JP. Phakomatoses. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00155-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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36
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Abstract
Neurofibromatosis type I is multisystem disorder with myriad manifestations, many of which involve the eye. Diagnostic findings include neurofibromas, lisch nodules, café-au-lait macules, freckling, optic pathway gliomas, and skeletal dysplasia. The responsible gene and its protein product, neurofibromin have been identified. Advances have been made in the understanding of the functions of neurofibromin. This has allowed better understanding of the many manifestations and will help identify potential treatments.
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Affiliation(s)
- Aaron Savar
- Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
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37
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Shamji MF, Benoit BG. Syndromic and sporadic pediatric optic pathway gliomas: review of clinical and histopathological differences and treatment implications. Neurosurg Focus 2007. [DOI: 10.3171/foc-07/11/e3] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓Optic pathway gliomas (OPGs) are the most common primary neoplasm of the optic pathway. These lesions usually present in childhood and can arise anywhere along the optic pathway; they occur more frequently in women; and they rarely undergo late progression. Management strategies after the initial diagnosis are controversial, compounded by the different behaviors exhibited by sporadic and syndromic tumors. Neurofibromatosis Type 1 (NF1), with aberrant oncogenic signaling and consequent predisposition to intracranial tumors, is the most common associated syndrome, with nearly 20% of NF1 patients developing OPGs. A comorbid NF1 diagnosis has implications for tumor location with greater predilection for optic nerve involvement, whereas chiasmal and postchiasmal lesions are more frequently seen in sporadic cases. Syndromic OPGs often exhibit more indolent behavior and lower rates of clinical progression, and the majority of these are diagnosed by routine neuroophthalmological screening. When treatment is indicated, however, the molecular abnormalities that constitute this syndrome can limit the available chemotherapy and radiotherapy options because clinicians fear secondary malignancy and cerebrovascular complications. Furthermore, radiotherapy early in life can impair an individual's intellectual development, endocrine function, and physical growth, thereby limiting the role of this modality in the treatment of this childhood lesion. Differential gene expression and histogenesis among sporadic and syndromic OPGs may account for the different tumor behaviors, but studies correlating specific genetic and proteomic changes with patient outcome are pending. Loss of heterozygosity at 10 and 17q are more common among patients with NF1, and Ki67 labeling intensity of 2–3% and low p53 labeling intensity seem prognostic of aggressive tumor behavior. Recent advances in the development of a preclinical mouse model of NF1-associated OPG will permit investigation into improved detection strategies and chemotherapeutic and radiotherapy treatment protocols.
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Affiliation(s)
- Mohammed F. Shamji
- 1Division of Neurosurgery, The Ottawa Hospital, Ottawa, Canada; and
- 2Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Brien G. Benoit
- 1Division of Neurosurgery, The Ottawa Hospital, Ottawa, Canada; and
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Evaluation of the outcome of treatment of facial deformities due to Recklinghausen’s disease. EUROPEAN JOURNAL OF PLASTIC SURGERY 2007. [DOI: 10.1007/s00238-007-0163-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McLoone EM, Buchanan TAS. Unusual macular lesions in a patient with neurofibromatosis type-1. Int Ophthalmol 2006; 26:115-7. [PMID: 16957876 DOI: 10.1007/s10792-006-9002-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 06/28/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Retinal involvement in neurofibromatosis type-1 (NF-1) is rare. METHODS We present a case report of a 49-year-old man with neurofibromatosis who developed bilateral macular lesions associated with gradual reduction of visual acuity. RESULTS Electrophysiology revealed an absent pattern electroretinogram. Fluorescein angiography demonstrated mottled hyperfluorescence of the maculae in the early-phase fluorescein angiogram followed by late staining of the lesions. CONCLUSIONS Our patient had unusual bilateral macular lesions which had some features suggestive of adult-onset foveomacular vitelliform dystrophy. To the best of our knowledge, there have been no previous reports of such macular lesions occurring in association with NF-1.
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Affiliation(s)
- Eibhlín M McLoone
- Department of Ophthalmology, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland.
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40
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Abstract
PURPOSE To describe the appearance and clinical course of small, white, endophytic calcific, peripheral lesions in developing retina of premature infants. METHODS Retrospective review of all patients evaluated for retinopathy of prematurity (ROP) at a level I neonatal intensive care unit (NICU) in San Jose, CA, between January 1, 2003, and December 31, 2004. Patients were examined either in the NICU or the affiliated outpatient clinic. Clinical examination consisted of dilated fundus examination with 360 degree scleral depression. Lesions were identified if they were white, calcific, peripheral, and transient. Ancillary testing and examination of family members was performed as indicated. RESULTS A total of 302 unique patients were screened for ROP. Ten lesions were identified in seven eyes. Three eyes had two lesions each. All lesions were unilateral. The size of the lesions was estimated to range between 500 and 700 microm. All lesions were located anterior to the vascularized retina, had minimal elevation on scleral depression, and demonstrated a predilection for the nasal and temporal raphe. Ultrasound findings demonstrated an elevated, hyperechoic mass with orbital shadowing. Computed tomography and magnetic resonance imaging tests did not demonstrate the lesions. Lesions involute slowly over a period of 6 months. There were no systemic findings or familial dispositions. CONCLUSION Immature retina in premature infants may predispose to the formation of transient reactive astrocytic hyperplasia. Development of mature retinal vascularization and spontaneous resolution of lesions should alleviate concerns regarding a more malignant diagnosis.
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Affiliation(s)
- Darius M Moshfeghi
- Department of Ophthalmology, Stanford University School of Medicine, California 94025, USA.
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41
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Ishiko S, Yoshida A, Kato Y, Kagokawa H. Occult retinal and choroidal lesions in neurofibromatosis type 1. Br J Ophthalmol 2006; 90:1067-8. [PMID: 16854838 PMCID: PMC1857214 DOI: 10.1136/bjo.2006.092718] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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42
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Meier P, Wiedemann P. Surgical Aspects of Vitreoretinal Disease in Children. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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43
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Eliott D, Schachat AP. Combined Hamartoma of the Retina and Retinal Pigment Epithelium. Retina 2006. [DOI: 10.1016/b978-0-323-02598-0.50037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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44
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Kreusel KM. Ophthalmological manifestations in VHL and NF 1: pathological and diagnostic implications. Fam Cancer 2005; 4:43-7. [PMID: 15883709 DOI: 10.1007/s10689-004-1327-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2004] [Accepted: 02/23/2004] [Indexed: 11/30/2022]
Abstract
Von Hippel-Lindau disease (VHL) and neurofibromatosis type 1 (NF 1) are hereditary multitumor syndromes that show associated ocular manifestations. Capillary retinal angioma, a benign vascular tumor, is the classical ocular lesion in VHL. It often appears as the first manifestation of the disease and may thus lead to the diagnosis of VHL. Since small angiomas can be treated easily by laser photocoagulation, a regular ocular screening of VHL patients is recommended. Ocular manifestations of NF 1 are more diverse as compared to VHL. Lisch nodules of the iris are an important diagnostic criteria of NF 1 since they can be found in almost every affected patient. Optic glioma can occur both intraorbitally and intracranially. The intraorbital form causes progressive protrusion of the globe and eventually blindness. Extension of the tumor beyond the chiasm worsens the prognosis quoad vitam. The hallmark of NF 1, namely cutaneous neurofibroma can cause visual impairment when affecting the skin of the eyelids. The rare intraorbital pexiform neurofibroma is associated with abnormal development of the orbital bones and infantile glaucoma. It may result in orbital mass effects and therefore may need surgical excision.
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Abstract
We report the case of a 31-year-old man who developed a combined hamartoma of the retina and retinal pigment epithelium in the left eye. The diagnosis was determined based on alterations discovered on fundus examination: hyperplasia of the retinal pigment epithelium cells and tortuosity of the vessels and glial epiretinal membrane. These modifications made it possible to differentiate the hamartoma from choroidal melanoma. The patient underwent photocoagulation therapy. His death due to stroke 4 years after therapy made it possible to analyze the eyeball. Histopathological examination revealed alterations due to retinal photocoagulation as well as alterations particular to the primary tumor: hypertrophy of the retinal pigment epithelium and glial and vascular overgrowth.
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Affiliation(s)
- M Munteanu
- Clinique Ophtalmologique, Timişoara, Roumanie
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Abstract
Microvascular retinal abnormalities, presenting in a corkscrew configuration, have been very recently described in patients with neurofibromatosis type 1 (NF-1). We report one more patient with NF-1 who had distinctive corkscrew retinal vessels superior and inferior to the fovea. This patient further supports the existence of a true association between this recently described retinal finding and NF-1.
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Affiliation(s)
- Panagiotis Karadimas
- Henry Dunant Hospital, 1st Department of Ophthalmology, 107 Mesogion Avenue, 11526 Athens, Greece.
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Pinna A, Carta A, Demontis S, Dore S, Carta F. Neuro-ophthalmological findings in neurofibromatosis type 1. Neuroophthalmology 2004. [DOI: 10.1080/01658100490887896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kadoi C, Nagaki Y, Hayasaka S. Unilateral peripheral retinal vascular occlusion in a young Japanese woman with neurofibromatosis-1. Retina 2003; 23:541-3. [PMID: 12972769 DOI: 10.1097/00006982-200308000-00017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Chiharu Kadoi
- Department of Ophthalmology, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan.
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Koyama Y, Shibuya Y, Ohira A. Bilateral retinal macroaneurysms with neurofibromatosis type 1. ACTA OPHTHALMOLOGICA SCANDINAVICA 2003; 81:200-1. [PMID: 12752065 DOI: 10.1034/j.1600-0420.2003.00036.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vianna RN, Pacheco DF, Vasconcelos MM, de Laey JJ. Combined hamartoma of the retina and retinal pigment epithelium associated with neurofibromatosis type-1. Int Ophthalmol 2002; 24:63-6. [PMID: 12201346 DOI: 10.1023/a:1016316114746] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Retinal tumors are occasionally seen in patients with neurofibromatosis type-1 (NF-1). These are usually astrocytic hamartomas or angiomas. Combined hamartoma of the retina and retinal pigment epithelium are tumors also described in NF-1, but this association has not been definitively established yet. METHOD We report on a child with NF-1, who presented a combined hamartoma of the retina and retinal pigment epithelium in both eyes. RESULTS The diagnosis of bilateral combined hamartoma of the retina and retinal pigment epithelium in our patient was performed on the basis of the ophthalmoscopic appearance of the lesions. NF-1 was diagnosed following the current international clinical criterion, supplemented by neuroimaging findings. CONCLUSION Despite the extreme rarity of this association, we believe that it is not coincidental, as the presence of a hamartomatous retinal lesion in a patient with a systemic hamartomatous neuroectodermic disease would be, at least, rational. Thus, NF-1 must be excluded in patients with combined hamartoma of the retina and retinal pigment epithelium.
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Affiliation(s)
- R N Vianna
- Department of Ophthalmology, Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil.
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