Abstract
Retinal capillary hemangioma (RCH) is strongly associated with von Hippel–Lindau (VHL) disease. Treatment of this sight-threatening condition is often unsatisfactory despite multiple treatment options available. We here describe an interesting case of a 50-year-old male with RCH located in the perifoveal region of the left eye. Subretinal bleed, exudation, and macular edema resulted in progressive deterioration of visual acuity. Fundus photography, fluorescein angiography, and optical coherence tomography (OCT) were used to serially monitor the lesion. After ruling out systemic lesions of VHL disease, the patient was subjected to direct laser photocoagulation of the lesion which resulted in further loss in vision with increase in bleed and exudation. Subsequently, the patient was given 2 monthly intravitreal injections of bevacizumab followed by laser photocoagulation of feeder arteriole. This combination therapy resulted in resolution of exudation, bleed, and macular edema with improvement in visual acuity. Thus, vision-threatening RCH may be safely and effectively treated by means of a combination therapy comprising of intravitreal bevacizumab and feeder vessel treatment.
References
McCabe CM, Flynn HW Jr, Shields CL, Shields JA, Regillo CD, McDonald R et al (2000) Juxtapapillary retinal capillary hemangiomas: clinical features and visual outcomes. Ophthalmology 107:2240–2249
Webster AR, Maher ER, Moore AT (1999) Clinical characteristics of ocular angiomatosis in von Hippel-Lindau disease and correlation with germline mutation. Arch Ophthalmol 117:371–378
Ridley M, Green J, Johnson G (1986) Retinal angiomatosis: the ocular manifestations of von Hippel-Lindau disease. Can J Ophthalmol 21:276–283
Wong WT, Agron E, Coleman HR, Tran T, Reed GF, Csaky K et al (2008) Clinical characterization of retinal capillary hemangioblastomas in a large population of patients with von Hippel-Lindau disease. Ophthalmology 115:181–188
Meyer-Schwickerath G (1961) The preservation of vision by treatment of intraocular tumors with light coagulation. Arch Ophthalmol 66:458–466
Annesley WJ, Leonard BC, Shields JA, Tasman WS (1977) Fifteen year review of treated cases of retinal angiomatosis. Trans Am Acad Ophthalmol Otolaryngol 83:446–453
Aiello LP, George DJ, Cahill MT et al (2002) Rapid and durable recovery of visual function in a patient with von Hippel-Lindau syndrome after systemic therapy with vascular endothelial growth factor receptor inhibitor SU5416. Ophthalmology 109:1745–1751
Ach T, Thiemeyer D, Hoeh AE, Beate K, Dithmar S (2010) Intravitreal bevacizumab for retinal capillary hemangioma: long term results. Acta Ophthalmol 88:e137–e138
von Buelow M, Pape S, Hoerauf H (2007) Systemic bevacizumab treatment of a juxtapapillary retinal haemangioma. Acta Ophthalmol Scand 85:114–116
Welch RB (1970) von Hippel-Lindau disease: the recognition and treatment of early angiomatosis retinae and the use of cryosurgery as an adjunct to therapy. Trans Am Ophthalmol Soc 68:367–424
Shields JA (1993) Response of retinal capillary hemangioma to cryotherapy. Arch Ophthalmol 111:551
Aaberg TM Jr, Aaberg TM Sr, Martin DF, Gilman JP, Myles R (2005) Three cases of large retinal capillary hemangiomas treated with verteporfin and photodynamic therapy. Arch Ophthalmol 123:328–332
Blodi CF, Russell SR, Pulido JS, Folk JC (1990) Direct and feeder vessel photocoagulation of retinal angiomas with dye yellow laser. Ophthalmology 97:791–795
Gaudric A, Krivosic V, Duguid G, Massin P, Giraud S, Richard S (2011) Vitreoretinal surgery for severe retinal capillary hemangiomas in von Hippel-Lindau disease. Ophthalmology 118:142–149
Singh AD, Nouri M, Shields CL, Shields JA, Perez N (2002) Treatment of retinal capillary hemangioma. Ophthalmology 109:1799–1806
Schmidt-Erfurth UM, Kusserow C, Barbazetto IA, Laqua H (2002) Benefits and complications of photodynamic therapy of papillary capillary hemangiomas. Ophthalmology 109:1256–1266
Bhattacharjee H, Deka H, Deka S, Barman MJ, Mazumdar M, Medhi J (2010) Verteporfin photodynamic therapy of retinal capillary hemangioblastoma in von Hippel-Lindau disease. Indian J Ophthalmol 58:73
Haining WM, Zweifach PH (1967) Fluorescein angiography in von Hippel-Lindau disease. Arch Ophthalmol 78:475–479
Archer DM, Deutman A, Ernest JT et al (1973) Arteriovenous communications of the retina. Am J Ophthalmol 75:224–241
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Agarwal, A., Kumari, N. & Singh, R. Intravitreal bevacizumab and feeder vessel laser treatment for a posteriorly located retinal capillary hemangioma. Int Ophthalmol 36, 747–750 (2016). https://doi.org/10.1007/s10792-016-0183-x
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DOI: https://doi.org/10.1007/s10792-016-0183-x