zografos tumors and pseudotumors of the optic disc
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Leonidas ZografosLausanne
4th Thessaloniki International Vitreo-Retinal Summer School, 16-21. 6.2014, Electra Palace
Tumors and pseudotumors of the optic disc
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Tumors and pseudo-tumors of the optic disc
1. Congenital anomalies of the O.D.2. Pigmented tumors and pseudo-tumors3. Tumors of the pigment epithelium of the retina4. Vascular tumors5. Glial tumors of the optic disc6. Tumors of the retina7. Metastatic tumors8. Leukemia and lymphoma9. Optic disc invasion from primary tumors of the
optic nerve
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Congenital anomalies of the optic disc
Optic pitMorning glory disc anomalyOptic nerve coloboma
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Prepapillary vascular anomalies
Arterial loops
Venous loops
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Pigmented tumors and pseudo-tumors
Optic disc melanocytosisMelanocytomaJuxtapapillary melanomaPrimary melanoma of the optic disc
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Optic disc Melanocytomas
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Edema of the optic disc 48%
Ophthalmoscopy +
Fluorescein angiography +
24%
Ophthalmoscopy –
Fluorescein angiography +
24%
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ICG 2:08 ICG 50:48
Fluo 0:37
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ICG 10:02
Fluo 0:50
07.2001
03.2003
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Visual field defects
Acuate and peripheral scotomas
27%
Enlargement of the blind spot
16%
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Visual field defects
Tubular vision 8%
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Obs. per. 2 y.
Obs. per. 6 y. Obs. per. 8 y.
Optic disc melanocytoma
Visual field defect
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Melanocytoma of the optic disc
Juxtapapillary CNVSurgical excision
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Obs. Period 8 yearsVis. Ac. 0.1
Melanocytoma of the optic disc
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Documented tumor growth
Obs. period ≥ 6 years 65%
Malignant transformation
Obs. period ≥ 10 years 5%
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Juxtapapillary melanoma
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Juxtapapillary melanoma
Proton Beam irradiationObs. Period. 1 year Vis. Ac. 04
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11.2004 10.2011 Vis. Ac. 0.2Vis. Ac. 1.0
Peripapillary melanoma
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Epipapillary melanoma
Invasion of the optic disc
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Retinoinvasive melanoma
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Primary melanoma of optic disk
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Tumors and pseudo-tumors of the retinal pigment epithelium
Congenital hypertrophy of the RPE
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Combined hamartomas of RPE
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Adenoma / Ca of the juxtapapillary RPE
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Adenoma / Ca of the juxtapapillary RPE
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Biopsy + proton beam irradiationObs. Period 7 years Vis. Ac. 0.01
Adenoma / Ca of the juxtapapillary RPE
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Vascular tumorsCavernous hemangioma of the optic discCapillary hemangioma of the optic discRacemose hemangiomatasisWyburn-Mason Syndrome
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Parapapillary hemangioblastoma
Sessile ExophyticEndophytic
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M. 19 yearsIsolated hemangioblastoma
Vis. Ac. 0.6
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Obs. period 1 year Vis. Ac. 0.7
Obs. period 5 years Vis. Ac. 0.6
Laser 4 sessions
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F. 30 yearsIsolated hemangioblastoma
Vis. Ac. 0.4
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Obs. period 2 years Vis. Ac. 0.5
Laser +2 sessions
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M. 12 yearsIsolated hemangioblastoma
Vis. Ac. 1.0
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Obs. period 3 years Vis. Ac. 0.01
Obs. period +2 m. Vis. Ac. 0.05
Obs. period +5 m. Vis. Ac. 0.4
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1 year post treatment Vis. Ac. 0.5
2 years post treatment Vis. Ac. 0.5
17 years post treatment Vis. Ac. 0.5
Laser 4 sessions
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M. 16 years
v. Hippel – Lindau s.Pheochromocytoma
19 years Vis. Ac. 0.1
Laser 4 sessionsSurgical excision
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Vis. Ac. 0.2
1 m. post treatment Vis. Ac. 0.1
Photodynamic Therapy (PDT)
1.5 yeras post treatment Vis. Ac. LP
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F. 35 years
v. Hippel – Lindau s.Cerrebellar hemangioblastoma
Vis. Ac. 0.1
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Proton beam radiotherapy
Vis. Ac. 0.1
6 month Vis. Ac. LP
7 years Vis. Ac. LP
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Vis. Ac. 0.8 Vis. Ac. 0.8
Obs. period 10 years
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M. 17 yearsv. Hippel – Lindau s.Cerrebellar hemangioblastoma
Vis. Ac. 0.1
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Racemose hemangiomatasisWyburn-Mason Syndrome
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Glial tumors of the optic disc
Astrocytic hamartoma
Noncalcified astrocytic hamartoma
Calcified astrocytic hamartoma
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Astrocytic hamartoma
Calcified astrocytic hamartoma
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Solitary progressive astrocytoma
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Primary tumors ofthe retina
Retinoblastoma
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Choroidal metastasis
Invasion of the optic disc
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Lymphomas and
Leukemias
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Optic disc invasion from primary tumors of the optic nerve
Optic nerve gliomaOptic nerve meningioma
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Conclusions
May be localized to the optic discAll this conditions are rare or extremely rare
Various- Benign and malignant- Primary and metastatic- Tumors and pseudo-tumors