PMC8138144_01
At the time of initial presentation. a Color fundus picture of the right eye; spoke-wheel like appearance of the fovea. b Optical coherence tomographic section of the right eye; inner retinal splitting. c Composite color fundus picture of the left eye; temporally located elevated mass-like lesion with the arc-like hard exudate aggregations cuffing the temporal border of the lesion. d Optical coherence tomographic section of the left eye; some degree of subfoveal subretinal fluid, inner retinal splitting, and high serous retinal detachment at the temporal retina. e Fluorescein angiography of the left eye, composite picture, and venous phase; the hypofluorescent lesion with stained border. f, g Fluorescein angiography of the left eye and late venous phase; vascular changes and their staining at the border of the hypofluorescent lesion.
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F1
There was a spoke-wheel like appearance at the right posterior pole (Fig. 1a), and the optical coherence tomography exhibited an inner retinal splitting (Fig. 1b). OS (Fig. 1c). Optical coherence tomography exhibited inner retinal splitting with extensive subretinal fluid temporal to the macula in OS (Fig. 1d). The mass lesion was hypofluorescent throughout the fluorescein angiogram with hyperfluorescent vascular dilatations at the stained lesion border consistent with VPTR in OS (Fig. 1e-g).
Left eye (just prior to CyberKnife session). a Composite color fundus picture, temporally elevated mass-like lesion, surrounding exudative detachment and previous laser burns. b A and B scan ultrasonographic images of the retinal mass exhibiting a medium internal reflectivity consistent with a proliferative tumor. c MRI picture of the lesion in T1-weighted image. d Computerized tomographic appearance of the lesion involving the CyberKnife treatment plan protecting the optic nerve, lens, and the fovea.
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F2
Although 3 consecutive dexamethasone implants were administered no satisfactory regression of the subretinal exudation was achieved (Fig. 2a). The tumor had medium to high internal reflectivity without any choroidal excavation (Fig. 2b). On MRI, the mass was relatively hyperintense with respect to the vitreous in the T1-weighted image (Fig. 2c). In the planning system (Multiplan version 4.6, Accuray, Sunnyvale, CA, USA), CT and both MRI sequences are manually co-registered using the insertion and the optic nerve and lens as principal landmarks (Fig. 2d).
Left eye (twenty months after the CyberKnife session). a Composite color fundus picture, partially regressed hard exudate cuff around the regressed lesion. b Optical coherence tomographic section and inner retinal splitting with hyperreflective hard exudate aggregates. c Composite optical coherence tomographic angiography of the posterior pole. d A and B scan ultrasonographic appearance of the fundus with the barely visible lesion.
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F3
Twenty months after the CyberKnife SRS, visual acuity remained stable with significant resorption of the hard exudates along with regression in tumor thickness located at the temporal retina, and the lesion could be observed barely by the ultrasonography (Fig. 3a-d).