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H. Heimann, S. E. Coupland, B. Damato; Choroidal Schwannoma: The Liverpool Experience. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5242.
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Uveal schwannomas are rare and have a wide variety of manifestations. The purpose of this poster is to summarize the Liverpool experience.
The clinical database of the ocular oncology service and the pathology archives were reviewed.
Five patients were diagnosed with choroidal schwannoma between 1995 and 2007. Case 1: A 28-year-old woman was referred with a large ciliochoroidal tumor in the left eye, which was diagnosed as melanoma and treated by enucleation and found to be a schwannoma. Case 2: A 37-year-old woman presented with a small, amelanotic choroidal tumor with dilated feeder vessels, in the left eye. The diagnosis of schwannoma was made by trans-scleral biopsy and the patient was observed, with no subsequent growth. Case 3: A 33-year-old man was referred with a left, juxtapapillary, amelanotic tumor surrounded by hard exudates. Fine-needle aspiration biopsy failed to provide a diagnosis and the patient was observed. The tumor grew and caused severe exudation with serous retinal detachment. The diagnosis was made by trans-retinal biopsy using a vitreous cutter. The detachment resolved with intraocular bevacizumab injections and the tumor regressed with repeated photodynamic therapy using verteporfin. Case 4: A 45-year-old man was referred with an 18mm choroidal tumor in the left eye, which was initially diagnosed as melanoma but on trans-retinal biopsy was found to be a schwannoma. The tumor was excised trans-sclerally, with a good result. Case 5: A 15-year-old man presented with a left, amelanotic, juxtapapillary tumor associated with inferior retinal detachment. The diagnosis was made by trans-retinal biopsy. The patient was kept under observation with no change in his condition.
Choroidal schwannomas present with diverse clinical manifestations, which may mimic melanoma. They can remain stable or can grow and cause exudative complications. They can be treated by local resection. Photodynamic therapy may be useful for unresectable tumors. Anti-angiogenic agents may induce resolution of serous retinal detachment.
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