MAR 13, 2017
Ocular Pathology/Oncology, Retina/Vitreous
Researchers have confirmed that laser photocoagulation is an effective tool for the treatment of retinal capillary hemangioblastoma (RCH) in patients with von Hippel-Lindau disease.
Although the efficacy of laser photocoagulation has been well established in several studies, treatment technique, tumor size suitable for treatment, and definition of success varies among studies.
This retrospective review included 176 patients with von Hippel-Lindau. Eyes with concomitant rhegmatogenous or tractional retinal detachment or with papillary RCH were excluded.
Laser photocoagulation was performed with a 532-nm green diode laser and applied directly to the RCH surface. The diameter of the spot was preset to obtain a 100- to 200-μm diameter on the retina, depending on the contact lens used. The power was set to 200 to 500 mW and the exposure time varied between 0.2 and 0.7 seconds, depending on the apparent tumor thickness. The goal was to achieve deep bleaching of the RCHs by penetrating as deeply as possible into the tumor at the first application.
Laser therapy inactivated 97% of all RCHs and 100% of RCHs measuring 1 disc diameter (DD) or less, requiring a mean of 1.3 laser sessions. Tumors 3 DD and larger were inactivated by laser therapy alone in 73% of cases, even when they were associated with exudative retinal detachment in the absence of tractional retinal detachment. Additional cryotherapy increased the overall success rate of all RCHs treated to 99%.
Subretinal fluid transiently increased in 7 eyes after the first laser session, but was controlled promptly with additional photocoagulation. Visual acuity remained stable in all eyes during the follow-up.
While some previous studies suggest observing smaller tumors, the authors of this study disagree. Eighteen patients in this study already lost their fellow eye because the patient was unaware of the disease. The authors advise treating all tumors 1 DD and smaller. It’s easy, effective and safe; however, periodic fundus screening remains necessary.
While the study does not compare laser therapy with another treatments, it nevertheless shows a high success rate even in large tumors, with an overall good visual prognosis.