Abstract
Purpose: :
Retinal angiomas are the most frequent and earliest disease manifestations in VHL patients. Treatment options vary according to size and location of the angiomas. Treatment is frequently difficult and outcomes are most variable. Clinical and histopathological studies have shown elevated intraocular levels of VEGF as well as the presence of the VHL gene in areas of increased VEGF expression in retinal angiomas. 3 patients with VHL disease treated with a course of intravitreal Anti-VEGF injections are presented.
Methods: :
3 patients with retinal angiomas due to VHL disease received a course of intravitreal Anti-VEGF therapy (1.25 mg bevacizumab or 0.5 mg ranibizumab).
Results: :
Case 1: 29 year old female with bilateral angiomas previously treated with laser therapy as well as PDT in both eyes. The right eye developed a large area of fibrovascular traction due to not successfully controlled angiomas. Prior to planned vitrectomy, 3 intravitreal ranibizumab injections were given, aiming to reduce the vascularization of the angiomas as well as the intraoperative risk of hemorrhage. After the injections, a slight reduction in angioma size and in the calliper of the feeding vessels was found.Case 2: 32 year old female with bilateral angiomas after previous laser treatment and PDT in both eyes. In her left eye a angioma revascularized 3 years after PDT. It was considered too large for direct laser therapy. 2 injections of intravitreal bevacizumab were performed. The angioma regressed sufficiently in order for us to able to perform successfully the laser photocoagulation.Case 3: 52 year old male with a large exudative angioma in his right eye. The exudation increased into the macula. 2 intravitreal injections of bevacizumab and 2 subsequent ranibizumab injections were performed. Exudation decreased and vision improved slightly.
Conclusions: :
Intravitreal Anti-VEGF Therapy appears to be a promising treatment option in patients with large or exudative retinal angiomas in VHL disease. This new therapeutic approach should be further investigated either as monotherapy or in combination with other treatment modalities.
Keywords: vascular endothelial growth factor • tumors • retina