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Fluorescein Angiography in Massive Retinal Gliosis
Vol. 103, No. 4
Letters to the Journal
593
Fluorescein Angiography in Massive Retinal Gliosis Jerald A. Bovino, M.D., Daniel F. Marcus, M.D., and Philip T. Nelsen, M.D. Retina Unit, St. Vincent Medical Center. Inquiries to Jerald A. Bovino, M.D., Retina Unit, St. Vincent Medical Center, 2213 Cherry St., Toledo, OH 43608. Massive retinal gliosis is a benign, noninvasive proliferation of well-differentiated glial cells. 1 The tumors represent non-neoplastic proliferation of the retinal glia in response to diverse pathologic states initiated by a variety of causative factors. 2 These factors include trauma, congenital malformations, chronic in flammation, glaucoma, phthisis bulbi, and in traocular neoplasms. Since massive retinal glio sis commonly occurs in blind eyes with opaque media, 2 it is unusual to have the opportunity to study the tumor with fluorescein angiography. A 67-year-old woman had had poor vision since birth. She had severe myopia (-26.00 diopters in each eye) and a history of glaucoma and dense nuclear sclerotic cataracts. Visual acuity was counting fingers in each eye. Ophthalmoscopic examination showed a large, smooth, salmon-colored peripapillary tumor in the right eye. A- and B-scan ultrasonography showed regions of both high and low internal reflectivity. We observed the patient for six months, and a bullous exudative retinal de-
Fig. 2 (Bovino, Marcus, and Nelsen). Late phases of the fluorescein angiogram show extensive staining of the tumor mass.
tachment developed inferior to the tumor, and the nuclear sclerotic cataract progressed. Cata ract extraction was done to facilitate examina tion of the tumor, and after surgery cleared the media, fluorescein angiography was per formed. The fluorescein angiogram showed a striking picture of multiple punctate hyperfluorescent leaks in the substance of the tumor in the early phases (Fig. 1). At 20 minutes, the late phases showed extensive staining of the tumor mass (Fig. 2). Enucleation was performed, and path ologic evaluation showed the typical picture of massive retinal gliosis. Distinguishing massive retinal gliosis from intraocular neoplasms (especially choroidal melanoma) may be difficult.2 The diagnosis of massive retinal gliosis should be considered in patients with a tumor characterized by early punctate hyperfluorescence and late staining on fluorescein angiography.
References
Fig. 1 (Bovino, Marcus, and Nelsen). Arterial phase of fluorescein angiogram in massive retinal gliosis. Multiple punctate hyperfluorescent leaks are seen in the tumor.
1. Nork, M. T., Ghobrial, M. W., Peyman, G. A., and Tso, M. O.: Massive retinal gliosis. Arch. Ophthalmol. 104:1383, 1986. 2. Yanoff, M., Zimmerman, L. E., and Davis, R. L.: Massive gliosis of the retina. Int. Ophthalmol. Clin. 11:211, 1971.
Letters to the Journal
593
Fluorescein Angiography in Massive Retinal Gliosis Jerald A. Bovino, M.D., Daniel F. Marcus, M.D., and Philip T. Nelsen, M.D. Retina Unit, St. Vincent Medical Center. Inquiries to Jerald A. Bovino, M.D., Retina Unit, St. Vincent Medical Center, 2213 Cherry St., Toledo, OH 43608. Massive retinal gliosis is a benign, noninvasive proliferation of well-differentiated glial cells. 1 The tumors represent non-neoplastic proliferation of the retinal glia in response to diverse pathologic states initiated by a variety of causative factors. 2 These factors include trauma, congenital malformations, chronic in flammation, glaucoma, phthisis bulbi, and in traocular neoplasms. Since massive retinal glio sis commonly occurs in blind eyes with opaque media, 2 it is unusual to have the opportunity to study the tumor with fluorescein angiography. A 67-year-old woman had had poor vision since birth. She had severe myopia (-26.00 diopters in each eye) and a history of glaucoma and dense nuclear sclerotic cataracts. Visual acuity was counting fingers in each eye. Ophthalmoscopic examination showed a large, smooth, salmon-colored peripapillary tumor in the right eye. A- and B-scan ultrasonography showed regions of both high and low internal reflectivity. We observed the patient for six months, and a bullous exudative retinal de-
Fig. 2 (Bovino, Marcus, and Nelsen). Late phases of the fluorescein angiogram show extensive staining of the tumor mass.
tachment developed inferior to the tumor, and the nuclear sclerotic cataract progressed. Cata ract extraction was done to facilitate examina tion of the tumor, and after surgery cleared the media, fluorescein angiography was per formed. The fluorescein angiogram showed a striking picture of multiple punctate hyperfluorescent leaks in the substance of the tumor in the early phases (Fig. 1). At 20 minutes, the late phases showed extensive staining of the tumor mass (Fig. 2). Enucleation was performed, and path ologic evaluation showed the typical picture of massive retinal gliosis. Distinguishing massive retinal gliosis from intraocular neoplasms (especially choroidal melanoma) may be difficult.2 The diagnosis of massive retinal gliosis should be considered in patients with a tumor characterized by early punctate hyperfluorescence and late staining on fluorescein angiography.
References
Fig. 1 (Bovino, Marcus, and Nelsen). Arterial phase of fluorescein angiogram in massive retinal gliosis. Multiple punctate hyperfluorescent leaks are seen in the tumor.
1. Nork, M. T., Ghobrial, M. W., Peyman, G. A., and Tso, M. O.: Massive retinal gliosis. Arch. Ophthalmol. 104:1383, 1986. 2. Yanoff, M., Zimmerman, L. E., and Davis, R. L.: Massive gliosis of the retina. Int. Ophthalmol. Clin. 11:211, 1971.