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Irene Barbazetto; Combined antiVEGF and Photodynamic Therapy for Hemangioblastoma of the Retina and the Optic Nerve. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3448.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the response of retinal and optic nerve hemangioblastoma to a combination treatment with photodynamic therapy (PDT) using Verteporfin (Visudyne,™ Valeant, Quebec, Canada) and intravitreal injections of anti-Vascular endothelial growth factor (VEGF) medications.
Retrospective case series of 4 patients with hemangioblastoma of the choroid or optic nerve. Changes in visual acuity (VA), optical coherence tomography (OCT) and fluoresceine (FA) and indocyanine green (ICG) angiography before and after treatment were evaluated.
Four eyes of 4 patients (4 male; mean age 48.7 years) were included. A total number of 7 hemangioblastomas were treated. Three patients were diagnosed with von Hippel-Lindau Disease. All patients received an intravitreal antiVEGF injection 1 - 2 weeks prior to PDT. Additional injections after PDT were given in case of persistent or recurrent edema. Persistent leakage on angiography was the bases for repeated PDT. Patients received an average of 2.5 PDT treatments (1-4). The men follow-up time was 18.3 months (5-24). Some degree of VA improvement was noted in all patients. On average patients gained 2.5 lines (1-5). Patients with lesions outside the macular were more likely to benefit with regard to functional gain. Improvement on OCT imaging, with reduction of retinal edema, subretinal fluid and/or lesion size was seen in all patients. Angiography confirmed a partial or complete closure after treatment in all patients. However recurrent leakage was seen in 4 of 5 patients.<br />
Treatment response varies depending on size and location of the hemangioblastoma. While anatomical and functional improvements are possible, complete and lasting angiographic closure is only rarely achieved.
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