title: Intravitreal bevacizumab and feeder vessel laser treatment for a posteriorly located retinal capillary hemangioma.
abstract: Retinal capillary hemangioma (RCH) is strongly associated with von Hippel-Lindau (VHL) disease. Treatment of this sight-threatening condition is often unsatisfactory despite multiple treatment options available. We here describe an interesting case of a 50-year-old male with RCH located in the perifoveal region of the left eye. Subretinal bleed, exudation, and macular edema resulted in progressive deterioration of visual acuity. Fundus photography, fluorescein angiography, and optical coherence tomography (OCT) were used to serially monitor the lesion. After ruling out systemic lesions of VHL disease, the patient was subjected to direct laser photocoagulation of the lesion which resulted in further loss in vision with increase in bleed and exudation. Subsequently, the patient was given 2 monthly intravitreal injections of bevacizumab followed by laser photocoagulation of feeder arteriole. This combination therapy resulted in resolution of exudation, bleed, and macular edema with improvement in visual acuity. Thus, vision-threatening RCH may be safely and effectively treated by means of a combination therapy comprising of intravitreal bevacizumab and feeder vessel treatment.
authors.affiliation: Stanley M. Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Aniruddha
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India.
authors.forename: Neha
authors.initials: N
authors.lastname: Kumari
authors.affiliation: Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, India. mankoo95@yahoo.com.
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Singh
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D001160:Arterioles / Q000601:surgery; D000068258:Bevacizumab / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005451:Fluorescein Angiography; D018324:Hemangioma, Capillary / Q000098:blood supply / Q000188:drug therapy*; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000601:surgery*; D019572:Retinal Neoplasms / Q000098:blood supply / Q000188:drug therapy*; D012171:Retinal Vessels / Q000601:surgery; D041623:Tomography, Optical Coherence; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab
keywords: Anti-VEGF; Feeder vessel therapy; Laser photocoagulation; Retinal capillary hemangioma; von Hippel–Lindau disease
references.citation: Arch Ophthalmol. 1993 Apr;111(4):551
references.pmid: 8470991
references.citation: Ophthalmology. 1990 Jun;97(6):791-5; discussion 796-7
references.pmid: 2374684
references.citation: Trans Am Ophthalmol Soc. 1970;68:367-424
references.pmid: 5535648
references.citation: Ophthalmology. 2000 Dec;107(12):2240-8
references.pmid: 11097604
references.citation: Am J Ophthalmol. 1973 Feb;75(2):224-41
references.pmid: 4697179
references.citation: Arch Ophthalmol. 2005 Mar;123(3):328-32
references.pmid: 15767474
references.citation: Ophthalmology. 2008 Jan;115(1):181-8
references.pmid: 17543389
references.citation: Ophthalmology. 2002 Jul;109 (7):1256-66
references.pmid: 12093647
references.citation: Acta Ophthalmol Scand. 2007 Feb;85(1):114-6
references.pmid: 17244223
references.citation: Ophthalmology. 2002 Sep;109(9):1745-51
references.pmid: 12208726
references.citation: Ophthalmology. 2011 Jan;118(1):142-9
references.pmid: 20801520
references.citation: Ophthalmology. 2002 Oct;109(10):1799-806
references.pmid: 12359597
references.citation: Can J Ophthalmol. 1986 Dec;21(7):276-83
references.pmid: 3801976
references.citation: Arch Ophthalmol. 1961 Oct;66:458-66
references.pmid: 14473182
references.citation: Acta Ophthalmol. 2010 Jun;88(4):e137-8
references.pmid: 19681788
references.citation: Arch Ophthalmol. 1967 Oct;78(4):475-9
references.pmid: 6068992
references.citation: Arch Ophthalmol. 1999 Mar;117(3):371-8
references.pmid: 10088816
references.citation: Indian J Ophthalmol. 2010 Jan-Feb;58(1):73-5
references.pmid: 20029153
references.citation: Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol. 1977 May-Jun;83(3 Pt 1):OP446-53
references.pmid: 888257