Canadian Retina Society (CRS) Position Statement on Intravitreal Injections and the Management of Retinal Diseases during the COVID-19 Crisis

The Executive of the CRS has reviewed recommendations from local, national and international Medical and Ophthalmology groups regarding the management of patients and the risks to health care workers during this COVID crisis.

The below commentary has been provided by the CRS Executive and endorsed by the COS Board of Directors. These comments and recommendations are based on the “conditions on the ground” that exist today at the time of this writing.

About Us

The Canadian Retina Society is composed of members of the Canadian Ophthalmological Society whose primary area of patient care consists of surgical and/or medical vitreoretinal (VR) disease.

The mission of the Canadian Retina Society is to maintain the highest quality of patient care and teaching, particularly as it relates to the investigation and treatment of vitreoretinal (VR) disease; promote the interchange of information and scientific material and facilitate meetings of those who have a special interest in the diagnosis and management of VR pathology; work with the Canadian Ophthalmological Society on matters relating to health advocacy, health policy, and clinical guidelines on a national level.

Education

Figure 1

Figure 1.-Imaging findings of circumscribed choroidal hemangioma. (A) Colour image of posterior pole focussed on elevated hypopigmented lesion superonasal to right optic nerve. (B) FAF showing the hypo-autofluorescent lesion with extensive hyperfluorescent serous retinal detachment.

Title:

Hiding in plain sight: a case of circumscribed choroidal hemangioma

Authors:

Andre S. Pollmann MD, Amit V. Mishra MD, Hesham Lakosha MD, Christopher D. Seamone MD, and Carolina Francisconi MD

Affiliation:

Department of Ophthalmology and Visual Sciences, Dalhousie University

Case:

A 35-year-old female was referred from for a 6-month history of a central scotoma and peripapillary edema in her right eye. Ocular history was significant for a retinal tear treated with laser retinopexy in the right eye 3 months prior. Corrected visual acuity was 6/9 in the affected right eye. Right fundus exam showed an oval hypopigmented elevated lesion measuring approximately two disc diameters at the superonasal aspect of optic nerve (Fig. 1A).

Optical coherence tomography (OCT) of the macula showed peripapillary serous retinal detachment (RD) extending to the inferior macula. OCT of the lesion demonstrated a dome-shaped choroidal mass and subretinal fluid. Fluorescein angiography showed early hyperfluorescence with late diffuse staining of the superonasal mass. Fundus autofluorescence showed the hypo-autofluorescent lesion with extensive serous RD (Fig. 1B). B and A-scan ultrasonography demonstrated an elevated mass with high internal reflectivity. Bloodwork was negative for evidence of tumors elsewhere. Based on these findings, a diagnosis of circumscribed choroidal hemangioma with associated serous RD was made. Treatment with photodynamic therapy (PDT) was arranged.

Comment:

Circumscribed choroidal hemangiomas are rare benign congenital vascular hamartomas of the choroid.1 Most are unilateral and, unlike diffuse choroidal hemangiomas, have no known associated systemic manifestations. Classically, a round orange-red elevated mass in the posterior pole is visible.2,3 However, hemangiomas may blend into the surrounding choroid and make clinical diagnosis difficult.

Multimodal imaging is important to differentiate suspected hemangiomas from other causes of serous RD and choroidal tumors, especially amelanotic choroidal melanoma or metastasis. Ultrasonography shows characteristic high internal reflectivity on A-scan and solid acoustic appearance on B-scan.3 Fluorescein angiography shows early lacy hyperfluorescence, which increases in later phases. Lesions typically do not enlarge but affect vision due to complications including progression of serous RD, photoreceptor degeneration, and cystoid macular edema.3,4 In symptomatic patients, early PDT is the treatment of choice.4,5

References:

1 Karimi S, Nourinia R, Mashayekhi A. Circumscribed Choroidal Hemangioma. J Ophthalmic Vis Res 2015; 10:320-8. https://doi.org/10.4103/2008-322X.170353.

2 Krohn J, Rishi P, Frøystein T, Singh AD. Circumscribed choroidal haemangioma: clinical and topographical features. Br J Ophthalmol 2019; 103:1448-52. https://doi.org/10.1136/bjophthalmol-2018-313388.

3 Shields CL, Honavar SG, Shields JA, Cater J, Demirci H. Circumscribed choroidal hemangioma: clinical manifestations and factors predictive of visual outcome in 200 consecutive cases. Ophthalmology 2001; 108:2237-48. https://doi.org/10.1016/s0161-6420(01)00812-0.

4 Mashayekhi A, Shields CL. Circumscribed choroidal hemangioma. Curr Opin Ophthalmol 2003; 14:142-9. https://doi.org/10.1097/00055735-200306000-00006.

5 Lee J, Lee CS, Kim M et al. Retinal fluid changes and therapeutic effects in symptomatic circumscribed choroidal hemangioma patients: a long-term follow up study. BMC Ophthalmol 2018; 18:321. https://doi.org/ 10.1186/s12886-018-0993-x.

The Canada Retina Society publishes an interesting and educational vitreo-retinal case monthly. We welcome submissions for consideration; please contact us at:

Snapshot of the Month Editors:

  • Ananda Kalevar, MD, University of Sherbrooke
  • Jason Noble, MD FRCSC, University of Toronto

Please note that the CRS reserves the right to edit Snapshot of the Month submissions

Professional Development

February 4, 2021

To our Valued Industry Partners:

At this time of year, traditionally our Board and staff would be gearing up to welcome you to our Annual Meeting. Due to the COVID-19 pandemic, the CRS Scientific Planning Committee is pivoting to organize a virtual meeting for Fall, 2021. Should circumstances change and the pandemic allow, we are also making tentative plans for small face-to-face gatherings to allow for more concentrated discussion and camaraderie during the Annual Meeting.

We acknowledge that a virtual meeting is a significant step-change from our traditional format, and we want to ensure we provide value in content and connection to both our physician and industry attendees. Your experiences and learnings from the past ten months of virtual meetings are valuable, and we welcome your comments and suggestions for how we can most effectively meet your expectations.

We appreciate your support and attendance at previous CRS events, and we look forward to connecting with you in a new and exciting format this year.

Sincerely,

Varun Chaudhary MD, FRCSC

Co-Chair, Scientific Planning Committee

2021 Canadian Retina Society Annual Meeting

Robert Gizicki MD, FRCSC, DABO

Co-Chair, Scientific Planning Committee

2021 Canadian Retina Society Annual Meeting

Canadian Retina Society Board Members

Amin Kherani, MD

Amin Kherani, MD

Alberta

President

Cynthia Qian, MD

Cynthia Qian, MD

Québec

Vice-President

James Whelan, MD

James Whelan, MD

Newfoundland

Past-President

Arif Samad, MD

Arif Samad, MD

Nova Scotia

Secretary-Treasurer

Alan Berger, MD

Alan Berger, MD

Ontario

Director, Advocacy

Varun Chaudhary, MD

Varun Chaudhary, MD

Ontario

Director, Continuing Professional Development

Robert Gizicki, MD

Robert Gizicki, MD

British Columbia

Co-Chair, Scientific Meeting

Jason Noble, MD

Ontario

Past Co-Chair, Scientific Meeting

Adverse Event Reporting

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