Korean J Ophthalmol.  2020 Apr;34(2):133-142. 10.3341/kjo.2019.0075.

Clinical Results of Various Treatments for Retinal Capillary Hemangioma

• KMID: 2507403
• DOI: http://doi.org/10.3341/kjo.2019.0075

Abstract

Purpose
We report the clinical outcomes of retinal capillary hemangioma (RCH) after the application of various treatments.
Methods
We performed a retrospective chart analysis of eight eyes treated for RCH between August 2009 and January 2018. During the follow-up period, the status and progression of the RCHs were checked by fundus photography, fluorescein angiography, and optical coherence tomography, and additional treatments were applied when necessary.
Results
Three of the five patients had bilateral RCH, and two had unilateral RCH. Six eyes received laser photocoagulation; two eyes received cryotherapy, and one eye received intravitreal Avastin injection. Three eyes each had intravitreal triamcinolone injection, subtenon triamcinolone injection, and intravitreal dexamethasone injection to control inflammation. Also, two patients took oral prednisolone, and one patient used prednisolone eye drops to control inflammation. Two eyes underwent vitrectomy and scleral buckling due to deterioration of the epiretinal membrane and vitreal traction, respectively. As a result of those treatments, the tumors were stable in five of the eight eyes. However, one eye is now in a pre-phthisis state, and one patient who refused treatment showed progression of the tumor, epiretinal membrane, and traction.
Conclusions
Because RCHs vary in size, the degree of inflammation, and symptoms, this disorder should be actively treated on a case-by-case basis. Fluorescein angiography should be used periodically to determine recurrence of the tumor or inflammation, and the appropriate treatment should be repeated as necessary. Moreover, regular systemic screening tests for von Hippel-Lindau disease should be performed in RCH patients to ensure that they have no abnormalities other than in the eye.

Keyword

Laser photocoagulation; Retinal capillary hemangioma; von Hippel-Lindau disease

Figure

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  Fig. 1 Clinical outcome of a case 1 patient. (A) Fundus photographs and (B) fluorescein angiography of the right eye of a 29-year-old patient at the initial visit. Three round, orange retinal masses <1.5 disc diameters with dilated feeder vessels and exudations were observed in the peripheral retina. Leakage of fluorescence associated with the lesions was revealed by fluorescein angiography. (C) The size of the masses and exudates decreased after two laser photocoagulation treatments. (D) Leakage around the lesions also decreased after two laser photocoagulation treatments.

• 

  Fig. 2 Clinical outcome of a case 2 patient. (A,B) Fundus photographs and (C) fluorescein angiography (FA) of the left eye of a 13-year-old patient before treatment. A tumor of 2.5 disc diameters with dilated vessels was found in the temporal retina, and exudates were deposited around the vessels. Leakage of fluorescence associated with the lesions was revealed by FA. Although laser photocoagulation was repeated, (D) fundus photographs and (E) optical coherence tomography showed vitreous traction with an epiretinal membrane, and tumor progression was not completely attenuated. (F) The retinal masses in the right eye were stable on FA after four laser photocoagulation treatments.

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  Fig. 3 Clinical outcome of a case 3 patient. (A) Fundus photograph and (B) fluorescein angiography (FA) of the left eye of a 35-year-old patient before cryotherapy. There were exudations with dilated feeder vessels, and (B) FA revealed leakage from the lesion. Seven years after cryotherapy and additional laser photocoagulation treatments, a (C) fundus photograph and (D) FA showed no dilated vessels, exudates, or leakage around the mass.

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  Fig. 4 Clinical outcome of a case 4 patient. (A) The fluorescein angiography (FA) of the right eye of a 33-year-old patient at the first visit revealed inflammation throughout the retina. (B) Fundus photography, (C) FA, and (D) optical coherence tomography showed a mass of 3 disc diameters before treatment. After two cryotherapy treatments, (E) the inflammation disappeared in the FA, but retinal traction worsened in (F) the fundus photograph, (G) FA, and (H) optical coherence tomography. (I–L) After scleral bucking, the right eye reached a stable state.

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  Fig. 5 Clinical outcome of a case 5 patient. (A,B) Fundus photographs of a 13-year-old patient at the initial visit. The retinal tumors were in the right inferotemporal peripheral retina and the left superotemporal retina. Nine years later, without any treatment, (C) the tumor in the right eye became enlarged, and (D) retinal traction and ERM had progressed in the left eye.

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