Retinal astrocytoma with exudative retinal detachment treated with photodynamic therapy in a young girl with tuberous sclerosis

Around 50% of patients with tuberous sclerosis have the manifestation of retinal astrocytomas. Symptomatic retinal astrocytomas are very rare, with no consensus on optimal treatment. A 7-year-old patient with tuberous sclerosis presented with progressive blurred vision in the right eye for more than half a year. On examination, best-corrected visual acuity was 20/30 in the right eye and 20/20 in the left eye. Dilated fundus examination of the right eye showed a well-circumscribed, elevated, opaque lesion, with surrounding lipid exudate, and retinal detachment involving the fovea. Spectral-domain optical coherence tomography of the right eye revealed an intraretinal lesion with adjacent subretinal fluid. A diagnosis of retinal astrocytoma with exudative retinal detachment was made. The patient was treated with verteporfin photodynamic therapy (PDT) on the lesion in the right eye. After 1 month, complete resolution of subretinal fluid was observed. At 21-month follow-up, the right eye vision was stable at 20/20, without ocular or systemic adverse events. In conclusion, PDT had a good safety profile in a cooperative pediatric patient, and was able to induce regression of astrocytoma as well as resolution of exudation with excellent visual outcome.