title: Current treatment modalities for exudative retinal hamartomas secondary to tuberous sclerosis: review of the literature.
abstract: BACKGROUND
  Retinal hamartoma is a common finding in tuberous sclerosis, but the symptomatic changes of this lesion have rarely been described. This evidence-based review evaluated the incidence of symptomatic retinal hamartoma and compared possible treatment modalities.
  
  
  METHODS
  We carried out a review of the literature using MEDLINE. Older publications not listed in MEDLINE were obtained from the reference list of currently published papers.
  
  
  RESULTS
  Three observational case series with a follow-up of up to 34 years included 93 patients and reported progression from a flat to a more elevated lesion without visual symptoms in nine patients (9.7%). Additional symptomatic changes were described in 11 case reports published over a period of three decades. The symptomatic alterations were caused by an enlarged tumour with leakage, macular oedema, accumulating lipoid exudates, serous retinal detachment (n = 8/11) and vitreous haemorrhage (n = 4/11). Most symptomatic cases involved a retinal hamartoma type 1 (n = 6/8). Spontaneous resolution of symptomatic exudative hamartomas occurred in three patients within 4 weeks, although a delayed resorption of subretinal fluid caused permanent visual impairment in one patient. Investigational reports described a slow resorption of subretinal fluid after argon laser photocoagulation (n = 2), although recurrent laser applications induced choroidal neovascularization and destruction of the neurosensory retina (n = 1). A vitrectomy was used to remove a vitreous haemorrhage in another reported patient. In one case, complete resorption of subretinal fluid and an increase in visual acuity was observed within 2 weeks after a single treatment with photodynamic therapy (PDT). No complications were noted during a follow-up of 4 years.
  
  
  CONCLUSIONS
  Symptomatic changes are very rare in retinal hamartomas secondary to tuberous sclerosis. Spontaneous resolution of subretinal fluid may occur within 4 weeks. If a macular oedema with increasing lipoid exudates persists over a period of 6 weeks, treatment should be considered. Although previous reports demonstrated possible visual stabilization after argon laser photocoagulation, vision-threatening complications can occur. Current treatment strategies may include PDT based on favourable anatomical and functional results.
authors.affiliation: Department of Ophthalmology, Philipps-University Marburg, Marburg, Germany. stefan.mennel@lycos.com
authors.forename: Stefan
authors.initials: S
authors.lastname: Mennel
authors.forename: Carsten H
authors.initials: CH
authors.lastname: Meyer
authors.forename: Silvia
authors.initials: S
authors.lastname: Peter
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Schmidt
authors.forename: Peter
authors.initials: P
authors.lastname: Kroll
mesh_terms: D005122:Exudates and Transudates; D006222:Hamartoma / Q000209:etiology / Q000628:therapy*; D006801:Humans; D017075:Laser Coagulation; D010778:Photochemotherapy; D019572:Retinal Neoplasms / Q000209:etiology / Q000628:therapy*; D014402:Tuberous Sclerosis / Q000150:complications*; D014821:Vitrectomy