July/August 2020 Image of the Month

Image of the Month, a recurring feature in Retinal Physician since 2006, spotlights diagnostic images captured by industry practitioners using innovative technology and diagnostic instruments.

Exophytic Papillary Angioma

TOPCON

Images Courtesy of Ass. Prof. Gerasimos Anastassiou, MD, PhD, Augenklinik Gelsenkirchen University Duisburg-Essen, Germany

BACKGROUND

A 50-year-old female patient with known history of von Hippel-Lindau disease. Her left eye is blind and the right eye was treated with focal laser coagulation in 1999 for a small retinal angioma in the temporal periphery. Since then no treatment of the right eye was necessary. For some weeks, she has blurred vision and on SD-OCT the general ophthalmologist found some intraretinal fluid next to the optic disc. The vision was still 20/20.

We performed a 9 x 9mm Swept Source OCT-A1 using the central fixation to get both macula and optic disc in one scan visualized. The SS-OCT-A of the superficial capillaries (A) was normal but in the deeper layer (B), a vascular structure was detected at the temporal margin of the optic disc. On B-Scan a solid intraretinal mass with confined vascular flow (C, arrow) was shown. There was no contact to RPE and the SS-OCT-A of the sub-RPE layers was normal, so that a juxtapapillary CNV could be excluded. The diagnosis of an exophytic papillary angioma was made. The dimension of the angioma (BxLxH 640 x 1028 x 276μm) was measured by vertical and horizontal B-Scans (D, E). The en-face mode (F) demonstrated much more detailed information about the two-dimensional extend of the angioma and the surrounding exudation compared to the fundus photo (G).

Because of the symptomatic clinical presentation, a systemic treatment with propranolol hydrochloride (3mg/kg) was initiated.

DIAGNOSIS

Exophytic Papillary Angioma

DRI OCT TRITON IMAGES:

A. Superficial Capillaries
B. Deep Capillaries
C. B-Scan
D. Vertical B-Scan
E. Horizontal B-Scan
F. En-face Mode
G. Color Fundus Image

*OCT Angiography is not available for sale in the U.S.

The opinions, ideas, views and assumptions expressed are the author's own and do not necessarily represent the views of Topcon, nor do they constitute advice from Topcon.

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