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.

Keywords: Anti-VEGF; Feeder vessel therapy; Laser photocoagulation; Retinal capillary hemangioma; von Hippel–Lindau disease.