van Overdam Koen A, Hajjaj Anass, Smid Lisette M, Kiliç Emine, de Jong Jan H
The Rotterdam Eye Hospital, Rotterdam, The Netherlands.
Rotterdam Ophthalmic Institute, Rotterdam, The Netherlands.
Case Rep Ophthalmol. 2023 Oct 16;14(1):546-554. doi: 10.1159/000530687. eCollection 2023 Jan-Dec.
The surgical treatment of intraretinal juxtapapillary retinal hemangioblastomas (JRHs) was previously contraindicated because of the significant risk of collateral damage to the macula and optic nerve. This case report discusses the effectiveness and safety of a novel surgical technique using intraocular bipolar diathermy forceps to coagulate feeder and draining blood vessels of an intraretinal JRH. The patient suffered from bilateral retinal hemangioblastomas with loss of visual function in one eye and the development of an intraretinal JRH in the other eye. Despite intensive treatment with intravitreal bevacizumab and subconjunctival triamcinolone acetonide, growth of the intraretinal JRH continued, macular exudation worsened, and visual acuity decreased. Surgical treatment was undertaken in which, first, the feeder and draining vessels of the JRH were identified by comparing the retinal imaging of the JRH with the imaging before the emergence of the JRH 4 years earlier. Then, retinal incisions were made above the blood vessels and parallel to the nerve fibers during a pars plana vitrectomy. Lastly, these vessels were lifted above the retinal surface and coagulated using intraocular diathermy forceps. Postoperatively, macular edema reduced, and visual acuity increased and remained stable for about 6 months. Using intraocular diathermy forceps, this case report demonstrates effective and safe intraretinal JRH blood vessel coagulation above the retinal surface. This novel surgical approach was able to delay the deterioration of visual acuity due to tumor growth and exudation in this patient. This suggests that coagulation with intraocular diathermy forceps can be considered an additional surgical treatment option for JRHs, especially those with an intraretinal growth pattern.
由于黄斑和视神经有严重的附带损伤风险，以往视网膜内近乳头黄斑旁视网膜血管瘤（JRH）的手术治疗被视为禁忌。本病例报告讨论了一种使用眼内双极透热电镊凝固视网膜内JRH的供血和引流血管的新型手术技术的有效性和安全性。该患者患有双侧视网膜血管瘤，一只眼视力丧失，另一只眼出现视网膜内JRH。尽管进行了玻璃体内注射贝伐单抗和结膜下注射曲安奈德的强化治疗，但视网膜内JRH仍持续生长，黄斑渗出加重，视力下降。进行了手术治疗，首先，通过将JRH的视网膜成像与4年前JRH出现前的成像进行比较，确定JRH的供血和引流血管。然后，在玻璃体切除术中，在血管上方并与神经纤维平行处进行视网膜切开。最后，将这些血管提升到视网膜表面上方，使用眼内透热电镊进行凝固。术后，黄斑水肿减轻，视力提高并在约6个月内保持稳定。本病例报告表明，使用眼内透热电镊在视网膜表面上方对视网膜内JRH血管进行凝固是有效且安全的。这种新型手术方法能够延缓该患者因肿瘤生长和渗出导致的视力恶化。这表明，眼内透热电镊凝固可被视为JRH的一种额外手术治疗选择，尤其是那些具有视网膜内生长模式的JRH。
