C Gonzalez Castano, R Salazar Mendes, J Castro Navarro, M Fonolla Gil, A Garcia Alonso, P Rozas Reyes (Oviedo, Spain)

Advantages:

To confirm the efficacy of laser photocoagulation in retinal capillary hemangioma’s treatment, but also the retinal complications associated to this procedure and to reveal the implications of its diagnosis in patients with von Hippel-Lindau disease.

Methods:

A male carrier of VHL gene with large-evolution loss of vision in his left eye presents with a retinal capillary hemangioma (RCH) and diffuse cystic edema at the posterior pole. Systemic work-up revealed bilateral kidney tumors, an adrenal nodule, a probable neuroendocrine pancreatic tumor and many hemangioblastomas in the spinal cord. We started laser photocoagulation in two sessions that was complicated by subretinal and vitreous hemorrhage and required additional 23G-vitrectomy. Three months later visual acuity had improved as a result of resolution of the macular edema.

Effectiveness / Safety:

RCH is the earliest and most frequent manifestation of von Hippel-Lindau disease. Its diagnosis forces to treat it early and to detect other visceral lesions. Laser photocoagulation is recommended for treatment of small-sized RCH. As complications may occur, such as subretinal and vitreous hemorrhages additional vitrectomy may be necessary.

Take home message:

Laser photocoagulation is the first-line treatment of small-sized RHC, but further therapy may be necessary to control ocular VHL manifestation.