Evanescent vaso-occlusive choroidal pseudo-tumor with acute painful onset: a presumed vortex vein occlusion

  • Irmela Mantel
  • Ann Schalenbourg
  • Leonidas Zografos
Retinal Disorders
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Abstract

Purpose

The aim of our study was to describe the clinical presentation of an unusual evanescent, exudative, choroidal pseudo-tumor with acute painful onset, and propose a pathogenesis.

Methods

We carried out a retrospective, observational study using the case series of three patients presenting with an evanescent, exudative, choroidal pseudo-tumor with acute painful onset. Ultra-widefield fluorescein and indocyanine green angiography (ICGA) using the Heidelberg Retina Angiograph and the Staurenghi 230 SLO Retina Lens were used to propose a pathogenesis of this unusual entity.

Results

In all three cases, acute ocular pain led to discovery of an exudative, partially hemorrhagic choroidal mass (thickness 2.4 mm–4.1 mm on ultrasound) that quickly regressed within weeks. In the subacute phase, all patients showed choroidal circulation abnormalities on dynamic wide-field ICGA in the affected quadrant, with delayed arterio-venous filling in two patients, and a poorly-defined vortex vein in the third. The choroidal circulation abnormalities resolved within 8–12 weeks, simultaneously with the spontaneous resolution of the choroidal pseudo-tumor. The findings evoked a self-resolving vortex vein occlusion in the corresponding quadrants with acute, painful choroidal exudation.

Conclusions

An evanescent, exudative, hemorragic choroidal pseudo-tumor with acute painful onset may be caused by a vortex vein occlusion. Future patients need to be studied with ICGA in the acute phase to confirm this hypothesis.

Keywords

Choroidal pseudo-tumor Vortex vein occlusion Choroidal ischemia Ocular pain Dynamic ultra-widefield angiography 
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Notes

Financial Support

None

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Shields CL, Salazar PF, Mashayekhi A, Shields JA (2009) Peripheral exudative hemorrhagic chorioretinopathy simulating choroidal melanoma in 173 eyes. Ophthalmology 116(3):529–535PubMedCrossRefGoogle Scholar
  2. 2.
    Shields JA, Mashayekhi A, Ra S, Shields CL (2005) Pseudomelanomas of the posterior uveal tract: the 2006 Taylor R. Smith Lecture. Retina 25(6):767–771PubMedCrossRefGoogle Scholar
  3. 3.
    Annesley WH Jr (1980) Peripheral exudative hemorrhagic chorioretinopathy. Trans Am Ophthalmol Soc 78:321–364PubMedCentralPubMedGoogle Scholar
  4. 4.
    Mantel I, Schalenbourg A, Zografos L (2012) Peripheral exudative hemorrhagic chorioretinopathy: polypoidal choroidal vasculopathy and hemodynamic modifications. Am J Ophthalmology 153(5):910–922CrossRefGoogle Scholar
  5. 5.
    Mantel I, Uffer S, Zografos L (2009) Peripheral exudative hemorrhagic chorioretinopathy: a clinical, angiographic, and histologic study. Am J Ophthalmol 148(6):932–938PubMedCrossRefGoogle Scholar
  6. 6.
    Silva VB, Brockhurst RJ (1976) Hemorrhagic detachment of the peripheral retinal pigment epithelium. Arch Ophthalmol 94(8):1295–1300PubMedCrossRefGoogle Scholar
  7. 7.
    Staurenghi G, Viola F, Mainster MA, Graham RD, Harrington PG (2005) Scanning laser ophthalmoscopy and angiography with a wide-field contact lens system. Arch Ophthalmol 123(2):244–252PubMedCrossRefGoogle Scholar
  8. 8.
    Algvere P (1976) Retinal detachment and pathology following experimental embolization of choroidal and retinal circulation. Graefes Arch Clin Exp Ophthalmol 201(2):123–134CrossRefGoogle Scholar
  9. 9.
    De Laey JJ (1983) Fluorescein angiography of the choroid in health and disease. Int Ophthalmol 6(2):125–138PubMedCrossRefGoogle Scholar
  10. 10.
    Gaudric A, Coscas G, Bird AC (1982) Choroidal ischemia. Am J Ophthalmology 94(4):489–498Google Scholar
  11. 11.
    Gaudric A, Sterkers M, Coscas G (1987) Retinal detachment after choroidal ischemia. Am J Ophthalmology 104(4):364–372Google Scholar
  12. 12.
    Nishikawa M, Matsunaga H, Takahashi K, Matsumura M (2009) Indocyanine green angiography in experimental choroidal circulatory disturbance. Ophthalmic Res 41(1):53–58PubMedCrossRefGoogle Scholar
  13. 13.
    Hayreh SS, Baines JA (1973) Occlusion of the vortex veins. An experimental study. Br J Ophthalmol 57(4):217–238PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Bischoff PM, Speiser P (1986) Angiographic study of the vortex vein circulation. Graefes Arch Clin Exp Ophthalmol 224(2):122–123PubMedCrossRefGoogle Scholar
  15. 15.
    Amalric P, Biau C, Cenac P (1969) Choroid changes of a triangular type. Bull Mem Soc Fr Ophtalmol 82:449–455PubMedGoogle Scholar
  16. 16.
    Amalric P (1971) Acute choroidal ischaemia. Trans Ophthalmol Soc U K 91:305–322PubMedGoogle Scholar
  17. 17.
    Takahashi K, Kishi S (2000) Remodeling of choroidal venous drainage after vortex vein occlusion following scleral buckling for retinal detachment. Am J Ophthalmology 129(2):191–198CrossRefGoogle Scholar
  18. 18.
    Chak M, Williamson TH (2003) Spontaneous suprachoroidal haemorrhage associated with high myopia and aspirin. Eye 17(4):525–527PubMedCrossRefGoogle Scholar
  19. 19.
    Hammam T, Madhavan C (2003) Spontaneous suprachoroidal haemorrhage following a valsalva manoeuvre. Eye 17(2):261–262PubMedCrossRefGoogle Scholar
  20. 20.
    Hayreh SS, Chopdar A (1982) Occlusion of the posterior ciliary artery. V. Protective influence of simultaneous vortex vein occlusion. Arch Ophthalmol 100(9):1481–1491PubMedCrossRefGoogle Scholar
  21. 21.
    Loeffler KU, Hayreh SS, Tso MO (1994) The effects of simultaneous occlusion of the posterior ciliary artery and vortex veins. A histopathologic study. Arch Ophthalmol 112(5):674–682PubMedCrossRefGoogle Scholar
  22. 22.
    Bonnet M (1984) Surgical occlusion of 2 vorticose veins in the treatment of decompensated senile macular degeneration. J Fr Ophtalmol 7(8–9):563–567PubMedGoogle Scholar
  23. 23.
    Bonnet M (1985) Surgical occlusion of 2 vortex veins in the treatment of decompensated senile macular degeneration. A longer-term evaluation. J Fr Ophtalmol 8(12):779–783PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Irmela Mantel
    • 1
    • 2
  • Ann Schalenbourg
    • 1
  • Leonidas Zografos
    • 1
  1. 1.Department of OphthalmologyUniversity of Lausanne, Jules Gonin Eye Hospital, Fondation Asile des AveuglesLausanneSwitzerland
  2. 2.University Eye Hospital Jules GoninLausanne 7Switzerland

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