Early surgical treatment of retinal hemangioblastomas.
OBJECTIVE
To evaluate the clinical course after early surgical treatment with excision of retinal hemangioblastomas (RHs) before development of major complications.


METHODS
Interventional case series of four eyes (four patients) with a peripheral RH that had not yet been treated by laser or cryotherapy prior to surgery. All eyes underwent 23-gauge vitrectomy with lesion excision. One patient underwent ligation of the feeder vessel prior to lesion excision. Best-corrected visual acuity and clinical course were assessed during a follow-up period of at least 4 years.


RESULTS
Four patients (mean age 27.3 years; range 19-32) were included, of whom two had von Hippel-Lindau syndrome. Visual acuity improved in three patients (mean 4.8 lines; range 3-10) and remained stable at 0.0 logMAR in one patient. There were no intraoperative complications. Postoperative complications included transient mild vitreous haemorrhage (n = 2), and local epiretinal membrane formation at the excision location (n = 1). At 4 years postoperatively, there were no long-term complications. There was one case of a new lesion, which was effectively treated with laser.


CONCLUSIONS
Vitrectomy with RH excision seems to be an effective approach for larger RHs and could be considered an early treatment option in selected cases. Postoperative complications were limited in scope of this case series. Important points to consider during vitrectomy are effective closure of feeder and draining vessels as well as complete removal of posterior hyaloid and epiretinal membranes in order to avoid postoperative vitreous haemorrhage and proliferative vitreoretinopathy.
The Rotterdam Eye Hospital, Rotterdam, The Netherlands.|The Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
Koen A
KA
van Overdam
The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Tom
T
Missotten
Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.
Emine
E
Kilic
The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Leigh H
LH
Spielberg
D000328:Adult; D005260:Female; D018325:Hemangioblastoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D019572:Retinal Neoplasms / Q000473:pathology / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy; D055815:Young Adult
diathermy forceps; feeder vessel ligation; lesion excision; pars plana vitrectomy; retinal hemangioblastoma; von Hippel-Lindau