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Verbeek S, Dalvin LA. Advances in multimodal imaging for diagnosis of pigmented ocular fundus lesions. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023:S0008-4182(23)00209-0. [PMID: 37480939 PMCID: PMC10796850 DOI: 10.1016/j.jcjo.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/25/2023] [Accepted: 07/06/2023] [Indexed: 07/24/2023]
Abstract
Pigmented ocular fundus lesions can range from benign to malignant. While observation is reasonable for asymptomatic benign lesions, early recognition of tumours that are vision or life threatening is critical for long-term prognosis. With recent advances and increased accessibility of multimodal imaging, it is important that providers understand how to best use these tools to detect tumours that require early referral to subspecialty centres. This review aims to provide an overview of pigmented ocular fundus lesions and their defining characteristics using multimodal imaging. We cover the spectrum of pigmented ocular fundus lesions, including freckle and focal aggregates of normal or near-normal uveal melanocytes, retinal pigment epithelium (RPE) hyperplasia, congenital hypertrophy of the RPE, RPE hamartoma associated with familial adenomatous polyposis, congenital simple hamartoma of the RPE, combined hamartoma of the retina and RPE (congenital hypertrophy of the RPE), choroidal nevus, melanocytosis, melanocytoma, melanoma, adenoma, and RPE adenocarcinoma. We describe key diagnostic features using multimodal imaging modalities of ultra-widefield fundus photography, fundus autofluorescence, optical coherence tomography (OCT), enhanced-depth imaging OCT, ultrasonography, fluorescein angiography, indocyanine green angiography, and OCT angiography (OCTA), with particular attention to diagnostic features that could be missed on fundus examination alone. Finally, we review what is on the horizon, including applications of artificial intelligence. Through skilled application of current and emerging imaging technologies, earlier detection of sight- and life-threatening melanocytic ocular fundus tumours can lead to improved patient prognosis.
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Affiliation(s)
- Sara Verbeek
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
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Li KX, Young BK, Besirli CG. Secondary Choroidal Neovascularization in Combined Hamartoma of the Retina and Retinal Pigment Epithelium. JOURNAL OF VITREORETINAL DISEASES 2022; 6:497-500. [PMID: 37009536 PMCID: PMC9954783 DOI: 10.1177/24741264211073875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a 4-year-old boy with a large, macula-involving combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) lesion with an associated choroidal neovascular membrane involving the fovea, characterized with multimodal imaging. Methods: Case report. Results: Given the low likelihood of visual improvement with intervention, observation was recommended and the CHRRPE remained stable on follow-up 4 months after presentation. Conclusion: CHRRPE is a rare congenital retinal lesion that is variably pigmented. Awareness of rare complications, such as CNVM, as seen in this pediatric case is paramount.
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Affiliation(s)
- Katie X. Li
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Benjamin K. Young
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
| | - Cagri G. Besirli
- Department of Ophthalmology and Visual Sciences, University of Michigan W.K. Kellogg Eye Center, Ann Arbor, MI, USA
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van der Sommen CM, van Romunde SHM, van Overdam K. Surgery for Combined Hamartoma of the Retina and Retinal Pigment Epithelium. Case Rep Ophthalmol 2021; 12:778-783. [PMID: 34720977 PMCID: PMC8525305 DOI: 10.1159/000518013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/20/2021] [Indexed: 11/22/2022] Open
Abstract
There is no consensus on whether and when surgical treatment is indicated for combined hamartoma of the retina and retinal pigment epithelium (CHRRPE). We aim to discuss the benefits of surgical intervention and techniques that may improve the outcome. A 24-year-old man experienced progressive visual loss for 6 months in his left eye due to CHRRPE. At presentation, visual acuity was 1.3 LogMAR and fundoscopy revealed extensive tractional pre- and epiretinal membranes, subretinal exudation, and a vasoproliferative tumor in the inferior periphery. A complete vitrectomy was performed, while paying special attention to vitreous shaving at the vitreous base and removal of vitreoschisis-induced vitreous cortex remnants (VCR) from the retinal surface posterior to the vitreous base. Tractional membranes and internal limiting membrane were peeled, and the vasoproliferative tumor was excised. Silicone oil tamponade was removed 11 weeks after surgery. No intra- or postoperative complications occurred. Visual acuity improved to 0.8 LogMAR and remained stable for 48-month follow-up. Vitreoretinal surgery can prevent complications that occur with CHRRPE. In addition, visual function may improve even if the initial visual acuity is low. Timely and complete vitrectomy with extensive membranectomy and detection and removal of VCR is recommended to avoid complications in challenging CHRRPE.
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Affiliation(s)
| | | | - Koen van Overdam
- Department of Vitreoretinal Surgery, The Rotterdam Eye Hospital, Rotterdam, The Netherlands
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Lazzarini TA, Al-Khersan H, Patel NA, Russell JF, Fan KC, De Oliveira G, Negron CI, Mavrofrides E, Berrocal AM. Peripheral combined hamartoma of the retina and retinal pigment epithelium with remote peripapillary choroidal neovascular membrane. Am J Ophthalmol Case Rep 2020; 20:100954. [PMID: 33083636 PMCID: PMC7551977 DOI: 10.1016/j.ajoc.2020.100954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To describe the first reported case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) associated with a remote choroidal neovascular membrane (CNVM). Observations A 19-month-old girl with a normal prenatal and infantile history presented with esotropia of the left eye. Fundus examination demonstrated a large, elevated, charcoal-colored lesion in the nasal equatorial retina. There was dragging of the nasal retinal vessels and a retinal fold, presumed to have resulted from nasal traction from the lesion. There was also subretinal hemorrhage in the peripapillary macula. Multimodal imaging demonstrated a peripapillary choroidal neovascular membrane (CNVM) underlying the retinal fold. There was no leakage within the tumor or secondary retinal neovascularization. Examination of the fellow eye was unremarkable. The patient was diagnosed with peripheral CHRRPE with associated peripapillary CNVM. She was treated with serial intravitreal bevacizumab to the affected eye which resulted in a reduction in leakage from the CNVM and resolution of the subretinal hemorrhage. The CHRRPE remained stable on follow-up. Conclusions Peripheral CHRRPE can rarely be associated with a remote CNVM.
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Gupta R, Fung AT, Lupidi M, Pappuru RR, Nayak S, Sahoo NK, Kaliki S, Yannuzzi L, Reid K, Lim L, Sacconi R, Dave V, Singh SR, Ayachit A, Gabrielle PH, Cai S, Lima LH, Querques G, Arevalo JF, Freund KB, Shields CL, Chhablani J. Peripapillary Versus Macular Combined Hamartoma of the Retina and Retinal Pigment Epithelium: Imaging Characteristics. Am J Ophthalmol 2019; 200:263-269. [PMID: 30689986 DOI: 10.1016/j.ajo.2019.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/18/2019] [Accepted: 01/18/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare clinical, optical coherence tomography (OCT), and fundus autofluorescence (FAF) characteristics of peripapillary vs macular variants of combined hamartoma of the retina and retinal pigment epithelium (combined hamartoma). DESIGN Retrospective observational, comparative case series. METHODS Setting: Multicenter collaborative study. STUDY POPULATION Fifty eyes with a clinical diagnosis of combined hamartoma. Observational Analysis: A comparative analysis of color fundus photographs (CFPs), OCT, and FAF was performed for peripapillary and macular variants of combined hamartoma. MAIN OUTCOME MEASURES Pigmentation and OCT features of macular and peripapillary combined hamartoma. RESULTS The review of imaging from 50 eyes of 49 patients diagnosed with combined hamartoma identified 18 (36%) peripapillary lesions, 27 (54%) macular lesions, and 5 (10%) peripheral lesions. A comparative analysis of peripapillary vs macular combined hamartoma identified differences in the following features: lesion pigmentation on CFPs corresponding to hypoautofluorescent FAF (88% vs 0%, P < .001) and OCT features of full-thickness involvement (88% vs 3%, P < .001), preretinal fibrosis (27% vs 81%, P < .001), maxi peaks (5% vs 88%, P < .001), intraretinal cystoid spaces (72% vs 40%, P < .038), outer plexiform layer involvement (5% vs 96%, P < .001), ellipsoid zone disruption (83% vs 3%, P < .001), RPE disruption (77% vs 3%, P < .001), and choroidal neovascularization (16% vs 0%, P = .028). CONCLUSIONS This comparative analysis identified a higher frequency of pigmentation with hypoautofluorescence, full-thickness retinal involvement, intraretinal cystoid spaces, ellipsoid zone disruption, RPE disruption, and choroidal neovascularization in peripapillary combined hamartoma. These findings suggest that lesions occurring near or at the optic nerve are associated with a more severe degree of pigmentary changes and retinal disruption than those located in the macula.
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Affiliation(s)
- Rajan Gupta
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases
| | - Adrian T Fung
- Westmead Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia; Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Marco Lupidi
- Department of Biomedical and Surgical Sciences, Section of Ophthalmology, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | | | - Sameera Nayak
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases
| | | | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L V Prasad Eye Institute, Hyderabad, India
| | - Lawrence Yannuzzi
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA; Department of Ophthalmology, New York University, New York, New York, USA; Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Kate Reid
- Department of Ophthalmology, Canberra Hospital, Canberra, Australian Capital Territory, Australia; School of Clinical Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lianne Lim
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vivek Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases
| | | | - Apoorva Ayachit
- Department of Vitreoretina, M M Joshi Eye Institute, Hubballi, Karnataka, India
| | - Pierre-Henry Gabrielle
- Ophthalmology Department, Dijon University Hospital, Dijon, France; Center for Taste and Feeding Behaviour, INRA, UMR1324, Dijon, France
| | - Sophie Cai
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Luiz H Lima
- Federal University of São Paulo, São Paulo, Brazil
| | - Giuseppe Querques
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - J Fernando Arevalo
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - K Bailey Freund
- LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear, and Throat Hospital, New York, New York, USA; Department of Ophthalmology, New York University, New York, New York, USA; Vitreous Retina Macula Consultants of New York, New York, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases.
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Gupta R, Pappuru RR, Dave VP, Chhablani J. Choroidal neovascularization associated with combined hamartoma of retina and retinal pigment epithelium: Multimodal imaging. Indian J Ophthalmol 2018; 66:1866-1868. [PMID: 30451207 PMCID: PMC6256883 DOI: 10.4103/ijo.ijo_992_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Combined hamartoma of retina and retinal pigment epithelium (CHRRPE) has been considered as a congenital benign entity with evidence of choroidal neovascularization membranes (CNVM) being associated with it in literature. This case series gives insight into the pathogenesis and the predisposing factors leading to CNVM formation in peripapillary CHRRPE using swept-source optical coherence tomography. In addition, lack of typical markers of CNVM (subretinal fluid/pigment epithelial detachment) in CHRRPE highlights the utility of optical coherence tomography angiography and the subtle optical coherence tomography findings such as “Bridge Sign” that could be instrumental in early diagnosis of CNVM in CHRRPE.
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Affiliation(s)
- Rajan Gupta
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek P Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Jay Chhablani
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Sandhu HS, Kim BJ. Combined hamartoma of the retina and RPE: A spectrum of presentation with epiretinal membrane masquerade. Can J Ophthalmol 2016; 51:e10-3. [PMID: 26874162 DOI: 10.1016/j.jcjo.2015.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/16/2015] [Accepted: 09/20/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Harpal S Sandhu
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Benjamin J Kim
- Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Joubert R, Bonnin N, Chiambaretta F, Bacin F. [Combined hamartoma of the retinal pigment epithelium and retina: case report]. J Fr Ophtalmol 2013; 36:533-6. [PMID: 23618734 DOI: 10.1016/j.jfo.2013.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 02/22/2013] [Accepted: 03/05/2013] [Indexed: 11/15/2022]
Abstract
We report the case of a 19-year-old woman with a combined hamartoma of the retinal pigment epithelium and retina incidentally discovered during her first eye exam. By way of this case, we describe and illustrate the epidemiological and clinical characteristics of the condition and its potential complications.
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Affiliation(s)
- R Joubert
- Service d'ophtalmologie, pôle médecine interne-ophtalmologie-ORL, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France
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Hamdi R, De Korvin H, Speeg-Schatz C, Szwarcberg J. Hamartome combiné de l’épithélium pigmentaire et de la rétine. J Fr Ophtalmol 2006; 29:e6. [PMID: 16557165 DOI: 10.1016/s0181-5512(06)73792-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Combined hamartoma of the retina and retinal pigment epithelium is a rare condition, characterized by a proliferation of the retinal pigmentary epithelium and retinal gliosis leading to a disorganization of the retina and papilla. This study aimed to demonstrate the advantages of early diagnosis and regular monitoring. OBSERVATIONS We report a series of four children followed between 2001 and 2004 with combined hamartoma of the retina and retinal pigment epithelium, with age of diagnosis ranging from 3 months to 8 years. The main reason for consultation was reduction of vision. The clinical examination objectified the existence of a slightly grayish peripapillary formation with tortuous retinal vessels. This condition was confirmed by angiography with fluorescein in three cases and by optical coherence tomography (OCT) in one case. Progression showed the persistence of low vision in all four cases and the appearance of a neovascular membrane in one case. DISCUSSION Combined hamartoma of the retina and retinal pigment epithelium is probably a congenital tumor whose pathogenesis has not yet been elucidated. The diagnosis is clinical and the patient can be thoroughly examined by retinal angiography and optical coherence tomography (OCT). In this disorder, it is important to eliminate retinoblastoma and malignant melanoma of the choroid, showing the advantage of radiological exploration. Progression is stationary; nevertheless a reduction in visual acuity can be related to an epiretinal membrane or a neovascular membrane. CONCLUSION Knowledge of the clinical aspect is essential to differentiate this condition from the malignant retinal processes. This tumor can progress in spite of its benign character. Regular follow-up is essential and can improve the visual prognosis.
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Affiliation(s)
- R Hamdi
- Service d'Ophtalmologie, Hôpitaux Civils, Colmar
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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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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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