Laser Photocoagulation for Peripheral Retinal Capillary Hemangioblastoma in von Hippel-Lindau Disease

Abstract

To study the efficacy and limits of laser photocoagulation for retinal capillary hemangioblastoma (RCH) of various sizes in von Hippel-Lindau disease. Retrospective study. The records of 176 patients with von Hippel-Lindau were reviewed retrospectively. Seventy-four patients with 304 RCHs in 100 eyes were treated primarily with laser photocoagulation. Eyes with concomitant rhegmatogenous or tractional retinal detachment or with papillary RCH were excluded. The treatment consisted of inactivating RCH using direct green laser photocoagulation with long-duration laser burns (0.1-0.7 seconds). The number of RCH lesions per eye, RCH size in disc diameter (DD) at diagnosis, the presence of retinal lipid exudation or subretinal fluid, and visual acuity were recorded. Final outcomes included RCH inactivation, posttreatment complications, and final visual acuity. Patient mean age was 28 years (range, 8-62). Mean follow-up duration after treatment was 4.5 years (range, 0.4-17.5). Median RCH size was 0.25 DD (range, 0.25-3.00). Laser alone inactivated 97% of RCHs. A mean number of 1.6 laser sessions (range, 1-8) were needed to achieve RCH inactivation. A single laser session allowed coagulating 77% of RCHs. Their median size was 0.50 DD (range, 0.25-1.50). More than 1 laser session was needed to inactivate 23% of RCHs. Their median size was 1 DD (range, 0.25-3.00). Among them, 29 (10% of all RCHs) needed additional laser session during the first 48 hours. Their median size was 1.5 DD (range, 0.5-3). Subretinal fluid transiently increased in 7 eyes after the first laser session and was controlled promptly by additional photocoagulation. Additional cryotherapy was needed only in 7 eyes with large RCH partially inactivated by laser. In all eyes, visual acuity remained stable during the follow-up. In the absence of tractional retinal detachment, laser photocoagulation allowed inactivating most RCHs up to 3 DD, even when they were associated with subretinal fluid. Laser photocoagulation alone inactivated 100% of RCHs up to 1 DD, and 73% of larger RCHs. In such cases, additional cryotherapy increased RCH inactivation to 94% so that 99% of all treated RCHs were finally inactivated.