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