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Lisette Marline Smid, Koen van Overdam, J H De Jong, Valentina Davidoiu, Johannes F De Boer, Koenraad Arndt Vermeer, Mirjam EJ Van Velthoven; Depth localization and treatment follow-up of a juxtapapillary retinal capillary hemangioma with optical coherence tomography angiography: a case report. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1785. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Juxtapapillary retinal capillary hemangiomas (JRCH) are rare benign vascular tumors that occur at the optic nerve head or within the juxtapapillary region. This tumor can be classified based on growth type (endophytic, sessile or exophytic), which corresponds to the location within the retina (resp. superficial, inner layers or outer layers). We report on the use of optical coherence tomography angiography (OCT-A) for classifying JRCH and for quantifying the response to intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment (bevacizumab) in a case of von Hippel-Lindau (VHL) disease.
A 46-year-old woman with VHL disease presented with a JRCH in her right eye (shown in fundus image week 0, figure 1A). After intraocular bevacizumab injections, the patient was also imaged with two OCT-A systems: a prototype swept-source phase-resolved Doppler OCT and a preliminary research version of Spectralis OCT-A software (Heidelberg Engineering, Germany). The detected blood flow was represented on en face images as well as superimposed on structural OCT B-scans. The depth location of the JRCH as well as its extent were determined and these features were compared between the different time points and between OCT-A systems.
OCT-A imaging of the lesion at week 1 (figure 1C,D) revealed abnormally located blood flow in both en face and cross sectional representations. The latter showed that the lesion was located within the inner layers of the retina, in particular the inner plexiform and nuclear layer. Therefore, the growth type was defined as sessile. The extent of the lesion seemed to decrease slightly after treatment (figure 1F,G). While both OCT-A systems could confirm the inner retinal location of the JRCH, the contrast between the abnormal flow network and surroundings seemed to be better on the Doppler OCT.
OCT-A may be valuable in determining the depth location of small JRCH, and thereby the growth type, which is relevant to decide between a surgical or non-surgical treatment approach. However, imaging the subtle evolution of the lesion over time with OCT-A is difficult due to the limited reproducibility. Thus, the apparently slightly decreased flow signal on OCT-A after treatment may not be significant.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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