Intravitreal anti-VEGF injection for the treatment of progressive juxtapapillary retinal capillary hemangioma: a case report and mini review of the literature
A 44-year-old man, known to have VHL disease was referred to our ophthalmology clinic for routine fundus examination in 2008. The patient had chronic renal failure after he underwent bilateral partial nephrectomy for renal cell carcinoma, and he also had spinal cord hemangioma diagnosed by spinal magnetic resonance imaging. On examination, his best corrected VA was 20/20 both eyes. Intraocular pressure was 12 mmHg right eye and 13 mmHg left eye. Results of slit-lamp examination of both eyes and fundus examination of the right eye were normal. Fundoscopy of the left eye revealed an exophytic juxtapapillary capillary hemangioma along the nasal margin of the disc. No serous retinal detachment or exudates were observed in the macular or peripapillary area (). Fluorescein angiography of the left eye showed early and late hyperfluorescence of the lesion with no leakage (). A computerized Humphrey automated perimeter (Humphrey-Zeiss, San Leandro, CA, USA) (program 30-2) threshold test for visual field (VF) was normal in both eyes. No action was undertaken, and the patient was asked to return to the clinic yearly for follow-up.\nOn subsequent follow-up visits, we noticed a progressive increase in the size of the hemangioma, which in 2012 reached a diameter double that of the optic disc (). Also, some exudates and a minimal late leakage were observed in the peripapillary region on fluorescein angiography (). VA and VF remained unchanged. Due to the rapid increase in size of the JRCH, we decided to treat the patient with IVR. After detailed discussion with the patient, informed consent was received and IVR (0.5 mg ranibizumab; Lucentis, Genentech, Inc, San Francisco, CA, USA) was performed as an off-label treatment. Three weeks after a single injection of IVR, vascular channels within the hemangioma became less prominent. Six months after the single IVR, fundus examination showed a fibrotic, yellow-white appearance as a result of tumor scarring, and only few vascular channels could be seen within the hemangioma (). Fluorescein angiography revealed a decrease in the vessels within the hemangioma and a decrease in late leakage (). During all follow up visits, VA remained unchanged. After IVR, there was no further increase in hemangioma size, no significant systemic or ocular adverse events associated with IVR were noted, and no additional injections were needed.