SlideShare une entreprise Scribd logo
1  sur  33
Télécharger pour lire hors ligne
Management of choroidal
     hemangioma

           By
           Hany EL-Defrawy, MVR
           Fellow
           BEH
Diffuse choroidal hemangioma
   Rare Sporodic Neuro-Oculocutaneous disorder
   Facial nevus flammeus
   Buphthalmos
   Diffuse choroidal hemangioma (Tomato-Catsup)
   Leptomeningeal hemangiomatosis
   Epilepsy
   MR
   Hemiplegia
Sw sn
Sw sn
Sw sn
Sw sn
Circumscribed choroidal hemangioma

 Uncommon,   benign vascular tumour
 Discrete, smooth round orange red mass
 Macular and peripapillary region
Causes of visual loss

1.   Refractive error
2.   Foveal distortion
3.   Transudative leakage and CMO
4.   Serous Retinal detachment with secondary
     photoreceptor damage
Diagnosis

 Ultrasongraphy
 FFA
 OCT
 MRI
Sw sn
Sw sn
When to treat?

 Visual acuity potential
 Extent of detachment
Why challenging?

 Limitedtherapeutic options (Why?)
 Surgery (Dangerous)
 Size
 Location
 Associated   SRF
Armamentarium
   External beam radiation therapy (5 observational
    studies)
   Proton beam therapy
   Brachytherapy
   Photodynamic therapy
   Cryotherapy
   Transpupillary thermotherapy
   Anti VEGF
   IVTA
   Combined therapy
Sw sn
Radiation

 Cataract
 Radiation optic neuropathy
 Retinopathy
 Increase incidence of osteosarcoma
 Chorioretinal atrophy
Other modalities

    Plaque Brachytherapy
1.   Murthy 2005
2.   Zografos 1996
    Proton Beam
    Stereotactic therapy (Gamma Knife)
    Anti VEGF
    PDT
PDT

 Anand  2003
 Bains et al 2004
 Singh et al 2005
 Huiskamp 2005
 Tsipursky
Sw sn
Ophthalmology 2009;116:100-105
 31 patients with CCH and symptoms
 Underwent PDT
 IV Verteporfin 6 mg/m 2
 689nm laser
 15 min laser 50j/cm 2 83 sec exposure
 1-4 treatment
 Follow up 12 month
    Primary end point
1.   Absence of exudative RD at 12 month
     follow up (FFA,OCT, Ophthalmoscopy)
    Secondary endpoint
1.   Visual acuity
2.   Tumour thickness decrease
3.   Adverse events
    Inclusion criteria
1.   18 with CCH height 5 mm and diameter 12 mm
2.   Exudative RD affecting the fovea
3.   No cataract within last 2 months
    Exclusion criteria
1.   NYHA Class III-IV
2.   Porphyria
3.   Liver disease
4.   Active hepatitis
Results
   82.8% 1 session
   13.8% 2 sessions
   3.4% 3 sessions
   Visual acuity increased mean 20/60 to 20/ 35
   CMO regressed and Exudative RD disappeared in all
    except 2 cases.
   CCH thickness decreased from 3 to 1.7 mm
   Visual fields showed resolution of central scotomas
   No adverse events
Sw sn
Sw sn
Am J ophthalmol 2010
 Retrospective
              study of 14 patients with
  symptommatic circumscribed choroidal
  hemangioma who underwent PDT± IVTA
             Shao Huang, James Fabian etal. Optometery and
              visual science , 2009.
 Symptomatic   visual loss
 Exudative Detachment
 Macular edema
 Subfoveal fluid
 Tumour encroaching to within 2 mm of the
  fovea.
   7.5 mm spot size
   Overlapping spots
   83 sec
   IVTA (0.1ml of 40 mg/ml)
   Baseline VA
   IOP
   Macular thickness
   10 eyes PDT
   4 PDT and IVTA
Conclusion

 Optimal treatment settings remains a matter
  of debate for CCH
 Variable number of spots
 Ranging Spot size (2500-7700µ)
 Ranging duration (60-83sec)
 Overlapping vs non overlapping spots
 Number of treatment sessions
Sw sn

Contenu connexe

Tendances

Scleritis professor 1001030
Scleritis professor 1001030Scleritis professor 1001030
Scleritis professor 1001030doc30845
 
Pre operative analysis for cataract surgery
Pre operative analysis for cataract surgeryPre operative analysis for cataract surgery
Pre operative analysis for cataract surgeryDr Rakhi Dcruz
 
Ocular Ultrasound: Techniques, Evidence, Pathology
Ocular Ultrasound: Techniques, Evidence, PathologyOcular Ultrasound: Techniques, Evidence, Pathology
Ocular Ultrasound: Techniques, Evidence, Pathologydpark419
 
Macular function tests
Macular function testsMacular function tests
Macular function testsabubaker77
 
Myopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudani
Myopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudaniMyopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudani
Myopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudaniAjayDudani1
 
Michael Duplessie Eye Department, Eye surgery and eye care
Michael Duplessie Eye Department, Eye surgery and eye careMichael Duplessie Eye Department, Eye surgery and eye care
Michael Duplessie Eye Department, Eye surgery and eye careMichael Duplessie
 
Michael Duplessie -Keratorefractive & lenticular surgery
Michael Duplessie -Keratorefractive & lenticular surgeryMichael Duplessie -Keratorefractive & lenticular surgery
Michael Duplessie -Keratorefractive & lenticular surgeryMichael Duplessie
 
Management of adult cataract II.ppt
Management of adult cataract II.pptManagement of adult cataract II.ppt
Management of adult cataract II.pptdocsuleman
 
Apocrine Hidrocystoma
Apocrine HidrocystomaApocrine Hidrocystoma
Apocrine Hidrocystomapinchasmd
 
Polypoidal Choroidal Vasculopathy
Polypoidal Choroidal VasculopathyPolypoidal Choroidal Vasculopathy
Polypoidal Choroidal Vasculopathymtodman
 
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Riyad Banayot
 
Granular Corneal Dystrophy
Granular Corneal DystrophyGranular Corneal Dystrophy
Granular Corneal Dystrophypinchasmd
 
MACULAR FUNCTION TEST
MACULAR FUNCTION TEST MACULAR FUNCTION TEST
MACULAR FUNCTION TEST JAMIL Akhtar
 
Inservice presentation/Age-related macular degeneration
Inservice presentation/Age-related macular degenerationInservice presentation/Age-related macular degeneration
Inservice presentation/Age-related macular degenerationgueste69ac1
 
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptxRETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptxIddi Ndyabawe
 

Tendances (20)

Scleritis professor 1001030
Scleritis professor 1001030Scleritis professor 1001030
Scleritis professor 1001030
 
Pre operative analysis for cataract surgery
Pre operative analysis for cataract surgeryPre operative analysis for cataract surgery
Pre operative analysis for cataract surgery
 
Ophthalmic Laser
Ophthalmic Laser Ophthalmic Laser
Ophthalmic Laser
 
Ocular Ultrasound: Techniques, Evidence, Pathology
Ocular Ultrasound: Techniques, Evidence, PathologyOcular Ultrasound: Techniques, Evidence, Pathology
Ocular Ultrasound: Techniques, Evidence, Pathology
 
Macular function tests
Macular function testsMacular function tests
Macular function tests
 
Myopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudani
Myopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudaniMyopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudani
Myopic CNVM -DIAGNOSIS AND MGT BY dr ajay dudani
 
Michael Duplessie Eye Department, Eye surgery and eye care
Michael Duplessie Eye Department, Eye surgery and eye careMichael Duplessie Eye Department, Eye surgery and eye care
Michael Duplessie Eye Department, Eye surgery and eye care
 
Michael Duplessie -Keratorefractive & lenticular surgery
Michael Duplessie -Keratorefractive & lenticular surgeryMichael Duplessie -Keratorefractive & lenticular surgery
Michael Duplessie -Keratorefractive & lenticular surgery
 
My experience
My experienceMy experience
My experience
 
Management of adult cataract II.ppt
Management of adult cataract II.pptManagement of adult cataract II.ppt
Management of adult cataract II.ppt
 
Apocrine Hidrocystoma
Apocrine HidrocystomaApocrine Hidrocystoma
Apocrine Hidrocystoma
 
Retinoblastoma
RetinoblastomaRetinoblastoma
Retinoblastoma
 
Polypoidal Choroidal Vasculopathy
Polypoidal Choroidal VasculopathyPolypoidal Choroidal Vasculopathy
Polypoidal Choroidal Vasculopathy
 
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...
Bilateral lens capsule rupture in a patient with previously undiagnosed alpor...
 
Granular Corneal Dystrophy
Granular Corneal DystrophyGranular Corneal Dystrophy
Granular Corneal Dystrophy
 
Hypotony Maculopathy
Hypotony MaculopathyHypotony Maculopathy
Hypotony Maculopathy
 
MACULAR FUNCTION TEST
MACULAR FUNCTION TEST MACULAR FUNCTION TEST
MACULAR FUNCTION TEST
 
Inservice presentation/Age-related macular degeneration
Inservice presentation/Age-related macular degenerationInservice presentation/Age-related macular degeneration
Inservice presentation/Age-related macular degeneration
 
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptxRETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
RETINAL DETACHMENT AND PREDISPOSING LESIONS lecture by Iddi.pptx
 
1ry 2ry glauucomas
1ry 2ry glauucomas 1ry 2ry glauucomas
1ry 2ry glauucomas
 

Similaire à Sw sn

MANAGEMENT OF DIABETIC MACULOPATHY
MANAGEMENT OF DIABETIC MACULOPATHYMANAGEMENT OF DIABETIC MACULOPATHY
MANAGEMENT OF DIABETIC MACULOPATHYSmith Snehal Sute
 
MANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDS
MANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDSMANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDS
MANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDSDr Samarth Mishra
 
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE MI...
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE  MI...THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE  MI...
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE MI...DrAbdelLatifsiam
 
Mellss yr4 opthalmology glaucoma primary open angle
Mellss yr4 opthalmology glaucoma  primary open angleMellss yr4 opthalmology glaucoma  primary open angle
Mellss yr4 opthalmology glaucoma primary open anglenur amalina aminuddin baki
 
Ocular surface squamous neoplasiaa.ppt1
Ocular surface squamous neoplasiaa.ppt1Ocular surface squamous neoplasiaa.ppt1
Ocular surface squamous neoplasiaa.ppt1Pushpraj Singh
 
Proptosis investigation & management.rdh
Proptosis investigation & management.rdhProptosis investigation & management.rdh
Proptosis investigation & management.rdhradhe4827
 
Robotic Radiosurgery Treatment for Eye Tumours
Robotic Radiosurgery Treatment for Eye Tumours  Robotic Radiosurgery Treatment for Eye Tumours
Robotic Radiosurgery Treatment for Eye Tumours duttaradio
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...daranisaha
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...semualkaira
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...eshaasini
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...semualkaira
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...JohnJulie1
 
MACULAR DISORDERS.pptx
MACULAR DISORDERS.pptxMACULAR DISORDERS.pptx
MACULAR DISORDERS.pptxvignapallavi
 
Retina Review - Part 2
Retina Review - Part 2Retina Review - Part 2
Retina Review - Part 2eyedoc34
 
RETINOBLASTOMA.pptx
RETINOBLASTOMA.pptxRETINOBLASTOMA.pptx
RETINOBLASTOMA.pptxManjuM74
 

Similaire à Sw sn (20)

Diabetic Maculopathy
Diabetic MaculopathyDiabetic Maculopathy
Diabetic Maculopathy
 
MANAGEMENT OF DIABETIC MACULOPATHY
MANAGEMENT OF DIABETIC MACULOPATHYMANAGEMENT OF DIABETIC MACULOPATHY
MANAGEMENT OF DIABETIC MACULOPATHY
 
MANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDS
MANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDSMANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDS
MANAGEMENT OF RETINOBLASTOMA & CURRENT TRENDS
 
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE MI...
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE  MI...THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE  MI...
THE RATIONALE AND TECHNIQUE OF LASER TREATMENT OF DIAB. RET. UNACCEPTABLE MI...
 
recurrent cscr
recurrent cscrrecurrent cscr
recurrent cscr
 
Diabetic retinopathy
Diabetic retinopathyDiabetic retinopathy
Diabetic retinopathy
 
Mellss yr4 opthalmology glaucoma primary open angle
Mellss yr4 opthalmology glaucoma  primary open angleMellss yr4 opthalmology glaucoma  primary open angle
Mellss yr4 opthalmology glaucoma primary open angle
 
Ocular surface squamous neoplasiaa.ppt1
Ocular surface squamous neoplasiaa.ppt1Ocular surface squamous neoplasiaa.ppt1
Ocular surface squamous neoplasiaa.ppt1
 
Proptosis investigation & management.rdh
Proptosis investigation & management.rdhProptosis investigation & management.rdh
Proptosis investigation & management.rdh
 
Central Serous Chorioretinopathy
Central Serous ChorioretinopathyCentral Serous Chorioretinopathy
Central Serous Chorioretinopathy
 
Central Serous Chorioretinopathy
Central Serous ChorioretinopathyCentral Serous Chorioretinopathy
Central Serous Chorioretinopathy
 
Robotic Radiosurgery Treatment for Eye Tumours
Robotic Radiosurgery Treatment for Eye Tumours  Robotic Radiosurgery Treatment for Eye Tumours
Robotic Radiosurgery Treatment for Eye Tumours
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
 
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
Optical Coherence Tomography Angiography Findings in Radiation Retinopathy: A...
 
MACULAR DISORDERS.pptx
MACULAR DISORDERS.pptxMACULAR DISORDERS.pptx
MACULAR DISORDERS.pptx
 
Retina Review - Part 2
Retina Review - Part 2Retina Review - Part 2
Retina Review - Part 2
 
RETINOBLASTOMA.pptx
RETINOBLASTOMA.pptxRETINOBLASTOMA.pptx
RETINOBLASTOMA.pptx
 

Dernier

ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptxNIKITA BHUTE
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 

Dernier (20)

ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptxORAL HYPOGLYCAEMIC AGENTS  - PART 2.pptx
ORAL HYPOGLYCAEMIC AGENTS - PART 2.pptx
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 

Sw sn

  • 1. Management of choroidal hemangioma By Hany EL-Defrawy, MVR Fellow BEH
  • 2. Diffuse choroidal hemangioma  Rare Sporodic Neuro-Oculocutaneous disorder  Facial nevus flammeus  Buphthalmos  Diffuse choroidal hemangioma (Tomato-Catsup)  Leptomeningeal hemangiomatosis  Epilepsy  MR  Hemiplegia
  • 7. Circumscribed choroidal hemangioma  Uncommon, benign vascular tumour  Discrete, smooth round orange red mass  Macular and peripapillary region
  • 8. Causes of visual loss 1. Refractive error 2. Foveal distortion 3. Transudative leakage and CMO 4. Serous Retinal detachment with secondary photoreceptor damage
  • 12. When to treat?  Visual acuity potential  Extent of detachment
  • 13. Why challenging?  Limitedtherapeutic options (Why?)  Surgery (Dangerous)
  • 14.  Size  Location  Associated SRF
  • 15. Armamentarium  External beam radiation therapy (5 observational studies)  Proton beam therapy  Brachytherapy  Photodynamic therapy  Cryotherapy  Transpupillary thermotherapy  Anti VEGF  IVTA  Combined therapy
  • 17. Radiation  Cataract  Radiation optic neuropathy  Retinopathy  Increase incidence of osteosarcoma  Chorioretinal atrophy
  • 18. Other modalities  Plaque Brachytherapy 1. Murthy 2005 2. Zografos 1996  Proton Beam  Stereotactic therapy (Gamma Knife)  Anti VEGF  PDT
  • 19. PDT  Anand 2003  Bains et al 2004  Singh et al 2005  Huiskamp 2005  Tsipursky
  • 22.  31 patients with CCH and symptoms  Underwent PDT  IV Verteporfin 6 mg/m 2  689nm laser  15 min laser 50j/cm 2 83 sec exposure  1-4 treatment  Follow up 12 month
  • 23. Primary end point 1. Absence of exudative RD at 12 month follow up (FFA,OCT, Ophthalmoscopy)  Secondary endpoint 1. Visual acuity 2. Tumour thickness decrease 3. Adverse events
  • 24. Inclusion criteria 1. 18 with CCH height 5 mm and diameter 12 mm 2. Exudative RD affecting the fovea 3. No cataract within last 2 months  Exclusion criteria 1. NYHA Class III-IV 2. Porphyria 3. Liver disease 4. Active hepatitis
  • 25. Results  82.8% 1 session  13.8% 2 sessions  3.4% 3 sessions  Visual acuity increased mean 20/60 to 20/ 35  CMO regressed and Exudative RD disappeared in all except 2 cases.  CCH thickness decreased from 3 to 1.7 mm  Visual fields showed resolution of central scotomas  No adverse events
  • 29.  Retrospective study of 14 patients with symptommatic circumscribed choroidal hemangioma who underwent PDT± IVTA  Shao Huang, James Fabian etal. Optometery and visual science , 2009.
  • 30.  Symptomatic visual loss  Exudative Detachment  Macular edema  Subfoveal fluid  Tumour encroaching to within 2 mm of the fovea.
  • 31. 7.5 mm spot size  Overlapping spots  83 sec  IVTA (0.1ml of 40 mg/ml)  Baseline VA  IOP  Macular thickness  10 eyes PDT  4 PDT and IVTA
  • 32. Conclusion  Optimal treatment settings remains a matter of debate for CCH  Variable number of spots  Ranging Spot size (2500-7700µ)  Ranging duration (60-83sec)  Overlapping vs non overlapping spots  Number of treatment sessions