To report on the methods of treatment and the visual outcome of eyes with retinal
capillary hemangioma (RCH).
Retrospective consecutive noncomparative case series.
Data on 68 patients with RCH were reviewed for the methods of treatment and visual
outcome.
Statistical analysis using cumulative multinomial logistic regression (generalized
estimating equations) was performed to determine significant predictors of visual
outcome.
Among 68 patients with RCH with von Hippel-Lindau disease (n = 31) and without von
Hippel-Lindau disease (n = 37), we identified 174 RCH in 86 eyes. The overall median
age at diagnosis of RCH was 30.8 years (range, 2.8-73.8 years). The RCH was bilateral
in 18 cases (26%), and a family history of von Hippel-Lindau disease was positive
in 19 cases (28%). Twenty-nine of the tumors (17%) touched the optic disc and were
classified as juxtapapillary RCH, and the remaining 145 (83%) were extrapapillary
in location. Ninety-nine (58%) RCH were 1.5 mm or smaller in size. The RCH were initially
managed by observation (46%), laser photocoagulation (25%), or cryotherapy (23%).
Small RCH (< or =1.5 mm in size; 63 of 99; 64%) and those touching the optic disc
(14 of 29; 48%) were more likely to be initially observed. Sixty-three (82%) of the
77 RCH that were initially observed remained stable for a median follow-up of 84 months.
The remaining 14 progressed and were successfully controlled with laser photocoagulation
or cryotherapy. Either laser photocoagulation or cryotherapy was effective as the
sole method of treatment in controlling 74% (26 of 35) and 72% (28 of 39) of extrapapillary
tumors, with a mean number of 1.2 and 1.1 sessions, respectively. In a multivariate
model, the only variables that were significantly related to final vision of </= 20/400
were poor initial vision (P = 0.01, odds ratio [OR], 8.5; 95% confidence interval
[CI], 1.7,42) and the presence of retinal/vitreous hemorrhage (P = 0.024, OR, 5.7;
95% CI, 1.3, 25.6).
RCH can be safely observed initially in selected cases. Laser photocoagulation and
cryotherapy are the mainstays of treatment in most cases. Early detection of RCH and
treatment before the onset of severe visual loss is recommended.