Sturzeneker Guilherme, Maia André, Morales Melina, N Belfort Rubens
Ocular Oncology Service, Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Retina Department, Retina Clinic, São Paulo, Brazil.
Case Rep Ophthalmol. 2019 Oct 1;10(3):327-333. doi: 10.1159/000502970. eCollection 2019 Sep-Dec.
The authors present a novel surgical approach for the treatment of retinal capillary hemangiomas (RCHs) secondary to von Hippel-Lindau (VHL) disease. This is a case report of a 23-year-old male patient with VHL that presented with multiple large RCHs and a thick epiretinal membrane (ERM) in his left eye, with best-corrected visual acuity (BCVA) of 20/80. This condition was surgically addressed with 23-gauge pars plana vitrectomy, ERM and internal limiting membrane peeling, and panretinal photocoagulation. Three monthly intravitreal injections of bevacizumab were administered after surgery. In a 14-month follow-up period, hemangiomas have regressed after laser therapy, macular anatomy has improved, retina remained completely attached, and there has been no development of new tumors or proliferative vitreoretinopathy. The patient achieved a BCVA of 20/40 in the treated eye. Panretinal photocoagulation combined with pars plana vitrectomy may be useful to reduce development of new capillary hemangiomas and reduce overall occurrence of complications in patients with VHL disease. Postoperative intravitreal injections of bevacizumab may have a role in this positive outcome.
作者介绍了一种治疗继发于冯·希佩尔-林道（VHL）病的视网膜毛细血管瘤（RCH）的新型手术方法。这是一例23岁男性VHL病患者的病例报告，该患者左眼出现多个大型RCH及一层增厚的视网膜前膜（ERM），最佳矫正视力（BCVA）为20/80。通过23G玻璃体切割术、ERM及内界膜剥除术以及全视网膜光凝术对该病症进行了手术治疗。术后每月进行3次玻璃体内注射贝伐单抗。在14个月的随访期内，激光治疗后血管瘤消退，黄斑解剖结构改善，视网膜保持完全附着，且未出现新肿瘤或增生性玻璃体视网膜病变。该患者治疗眼的BCVA达到了20/40。全视网膜光凝术联合玻璃体切割术可能有助于减少VHL病患者新毛细血管瘤的发生并降低并发症的总体发生率。术后玻璃体内注射贝伐单抗可能对这一积极结果起到了作用。
