Vitreoretinal Surgery for Severe Retinal Capillary Hemangiomas in von Hippel-Lindau Disease Two Cases by Bohdana Kalvodová, Zora Dubská, Magdalena Kováčová, Barbora Palasová, Czech Republic



To evaluate results of 23-G pars plana vitrectomy for severe cases of retinal capillary hemangiomas (RCHs) in Von Hippel-Lindau (VHL) disease.


Two eyes of 2 young patients (20 and 24 age) with severe exudative and tractional retinal detachment caused by RCHs had undergone vitreoretinal surgery with posterior hyaloid detachment with adjuvant triamcinolone, epiretinal membrane dissection, endolaser photocoagulation and silicone oil (SO) injection. In one eye equatorial retinectomy (R) with tumors endoresection was performed to remove the RCHs. The eye was one week before vitrectomy treated by intravitreal injection of bevacizumab. In other one eye the isolated medium RCH was treated by endolaser photocoagulation directly to the RCH without retinectomy (NR). Large bullous exudative retinal detachment was drained trans small retinotomy. Before R and NR intraocular pressure was increased above the perfusion pressure of central retinal artery. Follow-up period was 9 respectively 3 months.


Anatomical attachment of the retina was achieved at the end of the surgery, at 1 and 3 months postoperatively in both eyes. The best corrected visual acuity (BCVA) was checked using ETDRS charts and it was at 1 and 3 months postoperatively better then preoperatively in both eyes. At 4 months postoperatively BCVA in the eye with R was lower, but the same as preoperatively (BCVA 0.027). The reason for deterioration of BCVA was re-detachment during proliferative retinopathy and exudation. The patient had undergone reoperation with SO injection. At the end of follow-up period the retina was attached in the both eyes and BCVA was 0.16 (NR eye) and 0,09 (R eye).


The vitreoretinal surgery for advanced VHL eye disease with RCHs resection or directly endolaser photocoagulation is a good treatment method to improve or preserve visual function. Retinectomy with tumorectomy should be reserved only for the cases with prominent peripheral tractional detachment and multiple RCHs.


The paper was completed in the framework of Research project of Charles University PROGRES Q25/LF1/2


Bohdana Kalvodová, Zora Dubská, Magdalena Kováčová, Barbora Palasová
Charles University, Department of Ophthalmology
Czech Republic
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