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M. J. Saravia, A. B. Schlaen, M. Martinez Cartier, M. Iglicki; Juxtapapillary Retinal Capillary Hemangioma: Laser Photocoagulation and Intravitreal Bevacizumab Combined Treatment. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5239.
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© ARVO (1962-2015); The Authors (2016-present)
To show a case of juxtapapillary hemangioma treated with laser photocoagulation combined with intravitreal bevacizumab.Methods and Patient: A 34 years old male patient was initially examined in other centre were a bilateral edema was observed, along with a yuxtapapilary retinal capillary hemagioma in his right eye and a severe submacular exudation and tractional macular detachment associated with a temporally located retinal capillary hemangioma. After a neurological evaluation, a brain MRI was warranted. An hemangioblastoma of the cerebellum was detected. A diagnosis of Von Hippel Lindau disease was made. The cerebellar tumor was resected. After a follow up period of one year, the patient was referred to our service for evaluation and treatment. At examination, best corrected visual acuity (BCVA) was 20/40 in OD and no light projection in OS. Biomicroscopy examination was normal in both eyes. Intraocular pressure was of 15 mmhg in OD and 16 mmhg in OS. Posterior segment examination yielded an inferior juxtapapillary capillary retinal hemangioma of 1 mm diameter in OD. In the left eye there was a severe subretinal exudation at the posterior pole, which was completely distorted by tractional phenomena caused by a retinal capillary hemangioma of 3 disk areas, located at temporal periphery.
Laser photocoagulation was applied directly to the juxtapapillary retinal capillary hemangioma with a spot size of 500 microns, a power of 400 mW, and a duration of 0.2 msec.Four days after the procedure, OD visual acuity dropped to counting fingers. Fundus examination revealed a subretinal exudation from the hemangioma, extending to the fovea. The tumor seemed enlarged and edematous. An expectant management was decided. After a 2 weeks period of observation and without changes at funduscopy, a 2.5 mg/0.1 ml intravitreal bevacizumab injection was done.Three weeks later a noteworthy reduction of the tumor size was seen, along with a disappearance of the submacular exudation, and a partial recovery of the best corrected visual acuity to 20/100 in OD.
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