title: Persistent exudative retinal detachment after photodynamic therapy and intravitreal bevacizumab injection for multiple retinal capillary hemangiomas in a patient with von Hippel-Lindau disease.
abstract: Photodynamic therapy (PDT) has been used in treating peripheral retinal capillary hemangioma (RCH) with satisfactory results. We report a rare case of von Hippel-Lindau (VHL) disease with three large peripheral RCHs, treated with PDT and intravitreal bevacizumab injection (IVB), who developed persistent bullous exudative retinal detachment (RD) despite significant tumor regression. The patient is a sporadic case of VHL disease, with a de novo nonsense mutation in codon 161 with C → T transition at nucleotide position 694 of the VHL gene. Multiple RCHs were noted in both eyes. Four small RCHs were found in the left eye and were treated with laser photocoagulation. Three large RCHs in the peripheral retina of the right eye were complicated with cystoid macular edema and subretinal fluid accumulation. The RCHs were treated with PDT combined with IVB, and bullous exudative RD developed on the second day after treatment. Three months after PDT, the tumors had regressed significantly, but exudative RD persisted, despite multiple IVB and intravitreal triamcinolone acetonide injection (IVTA). External drainage with sclera buckling, IVB, and IVTA were performed, and the retina attached after surgical intervention. The application of PDT in the treatment of RCHs and its possible complications are discussed.
authors.affiliation: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
authors.forename: Fang-Yi
authors.initials: FY
authors.lastname: Tsai
authors.affiliation: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC. Electronic address: leliew@vghtpe.gov.tw.
authors.forename: Ling-Ing
authors.initials: LI
authors.lastname: Lau
authors.affiliation: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Fenq-Lih
authors.initials: FL
authors.lastname: Lee
authors.affiliation: Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Ophthalmology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Shui-Mei
authors.initials: SM
authors.lastname: Lee
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000068258:Bevacizumab; D005260:Female; D018324:Hemangioma, Capillary / Q000188:drug therapy*; D006801:Humans; D058449:Intravitreal Injections; D010778:Photochemotherapy / Q000009:adverse effects*; D012163:Retinal Detachment / Q000139:chemically induced*; D019572:Retinal Neoplasms / Q000188:drug therapy*; D055815:Young Adult; D006623:von Hippel-Lindau Disease / Q000150:complications*
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: exudative retinal detachment; photodynamic therapy; retinal capillary hemangioma; von Hippel–Lindau