A rare clinical case of multifocal retinal vasoproliferative tumor: Diagnosis and treatment tactics

Abstract

Objective. This article presents a clinical case of multifocal vasoproliferative tumor (VPT) of the retina and its successful treatment. In March 2020, a 28-year-old man with progressive deterioration of vision in the left eye referred to the Khabarovsk Branch of Fyodorov Eye Microsurgery Federal State Institution. Vis = OD 1.0; OS = 0.1 n/c. Anterior-posterior axis: OD = 23.11 mm, OS – 22.61 mm. Intraocular pressure (IOP): OD = 18 mm Hg, OS = 16 mm Hg. In the macular area of the left eye, high retinal edema and isolated deposits of hard retinal exudates were determined. In the equator and periphery, confluent fields of deposits of hard exudates with areas of capillary vascular lacunae with massive exudation were observed. Optical coherence tomography detected a high macular edema with detachment of the pigment and neuroepithelium. B-scanning of the vitreous cavity found no neoplasms of the eye choroid. The diagnosis of vasoproliferative tumor of the retina was established. An intravitreal Ozurdex implant was injected in the left eye. One month later, moderate reduction of macular edema and the subretinal fluid layer occurred. At the second stage, an incomplete panretinal laser coagulation of the retina was performed. Two weeks later, transpupillary thermotherapy (TTT) of the VPT localization zones was performed as the main treatment stage. One month later, a significant reduction in edema and the formation of fibrosis of the VPT were observed. The best-corrected visual acuity (BCVA) of the left eye increased significantly – to 0.9. The IOP level was 19 mm Hg. Three months after TTT, the BCVA of the left eye was 1.0. In the macular area, all VPT fragments were subject to fibrosis; in the parafoveal area, flat detachment of the neuroepithelium, up to 20 μm, and isolated hard exudates remained. Thenanatomical structure of the macular area was restored.