Treatment Of Retinal Capillary Hemangioma Research Articles

Treatment of retinal capillary hemangioma using 810 nm infrared laser.

Presentation of the efficacy of infrared laser for the treatment of retinal capillary hemangioma (RCH). The treatment and follow-up of nine eyes (fourteen tumors of different sizes and localizations) in seven patients (five children) with RCH. Infrared diode laser (810 nm) was used for modified transpupillary thermotherapy (TTT) in long exposition mode and power between 200 and 1200 mW with a beam diameter of 2 mm (indirect ophthalmoscope, +28 D or +40 D lens) or 0.5 mm-3 mm (slit-lamp) depending on the diameter and localisation of the hemangioma. We achieved complete destruction of the tumor with flat chorioretinal atrophic scar in all cases. Only one tumor regrowth was observed and re-treatment in this case was necessary. Treatment was combined with brachytherapy in a one case. There was one serious complication- total exudative retinal detachment, causing permanent deterioration in visual acuity despite pars plana vitrectomy (PPV). Other complications such as haze and vitreal hemorrhage were transient. The final best corrected visual acuity (BCVA) ranged from 20/20 to counting fingers at 2 feet. Infrared laser can be considered an acceptable therapeutic option for RCH especially for centrally localized lesions. We believe that the role of this therapy will increase in the future.

Persistent exudative retinal detachment after photodynamic therapy and intravitreal bevacizumab injection for multiple retinal capillary hemangiomas in a patient with von Hippel–Lindau disease

Photodynamic therapy (PDT) has been used in treating peripheral retinal capillary hemangioma (RCH) with satisfactory results. We report a rare case of von Hippel-Lindau (VHL) disease with three large peripheral RCHs, treated with PDT and intravitreal bevacizumab injection (IVB), who developed persistent bullous exudative retinal detachment (RD) despite significant tumor regression. The patient is a sporadic case of VHL disease, with a de novo nonsense mutation in codon 161 with C → T transition at nucleotide position 694 of the VHL gene. Multiple RCHs were noted in both eyes. Four small RCHs were found in the left eye and were treated with laser photocoagulation. Three large RCHs in the peripheral retina of the right eye were complicated with cystoid macular edema and subretinal fluid accumulation. The RCHs were treated with PDT combined with IVB, and bullous exudative RD developed on the second day after treatment. Three months after PDT, the tumors had regressed significantly, but exudative RD persisted, despite multiple IVB and intravitreal triamcinolone acetonide injection (IVTA). External drainage with sclera buckling, IVB, and IVTA were performed, and the retina attached after surgical intervention. The application of PDT in the treatment of RCHs and its possible complications are discussed.

Treatment of retinal capillary hemangioma

Objective To report on the methods of treatment and the visual outcome of eyes with retinal capillary hemangioma (RCH). Design Retrospective consecutive noncomparative case series. Participants Data on 68 patients with RCH were reviewed for the methods of treatment and visual outcome. Methods Statistical analysis using cumulative multinomial logistic regression (generalized estimating equations) was performed to determine significant predictors of visual outcome. Results Among 68 patients with RCH with von Hippel-Lindau disease (n = 31) and without von Hippel-Lindau disease (n = 37), we identified 174 RCH in 86 eyes. The overall median age at diagnosis of RCH was 30.8 years (range, 2.8–73.8 years). The RCH was bilateral in 18 cases (26%), and a family history of von Hippel-Lindau disease was positive in 19 cases (28%). Twenty-nine of the tumors (17%) touched the optic disc and were classified as juxtapapillary RCH, and the remaining 145 (83%) were extrapapillary in location. Ninety-nine (58%) RCH were 1.5 mm or smaller in size. The RCH were initially managed by observation (46%), laser photocoagulation (25%), or cryotherapy (23%). Small RCH (≤1.5 mm in size; 63 of 99; 64%) and those touching the optic disc (14 of 29; 48%) were more likely to be initially observed. Sixty-three (82%) of the 77 RCH that were initially observed remained stable for a median follow-up of 84 months. The remaining 14 progressed and were successfully controlled with laser photocoagulation or cryotherapy. Either laser photocoagulation or cryotherapy was effective as the sole method of treatment in controlling 74% (26 of 35) and 72% (28 of 39) of extrapapillary tumors, with a mean number of 1.2 and 1.1 sessions, respectively. In a multivariate model, the only variables that were significantly related to final vision of ≤ 20/400 were poor initial vision ( P = 0.01, odds ratio [OR], 8.5; 95% confidence interval [CI], 1.7,42) and the presence of retinal/vitreous hemorrhage ( P = 0.024, OR, 5.7; 95% CI, 1.3, 25.6). Conclusions RCH can be safely observed initially in selected cases. Laser photocoagulation and cryotherapy are the mainstays of treatment in most cases. Early detection of RCH and treatment before the onset of severe visual loss is recommended.

Transpupillary Thermotherapy for Retinal Capillary Hemangioma in von Hippel-Lindau Disease

Retinal capillary hemangiomas are a common manifestation of von Hippel-Lindau disease. We report the treatment of a peripapillary retinal capillary hemangioma in the left eye of a 30-year-old woman with this condition, using infrared diode laser transpupillary thermotherapy (TTT). The hemangioma was evaluated before and after treatment by ophthalmoscopy, fundus fluorescein angiography, and Doppler ultrasonography. Infrared diode laser TTT was delivered over 3 sessions during a period of 22 weeks, resulting in an improvement in visual acuity from counting fingers to 6/24 and a marked decrease in exudates surrounding the hemangioma. Doppler ultrasonography demonstrated a decrease in intralesional blood flow from 7 cm per second to less than 3 cm per second, together with a decrease in the size of the lesion. Infrared diode laser TTT provides a useful modality in the treatment of retinal capillary hemangiomas, and may be particularly favorable for peripapillary lesions because of its relatively nondestructive characteristics.