Long-term results of laser treatment for retinal angiomatosis in von Hippel-Lindau disease.

PURPOSE: In von Hippel-Lindau disease (VHL), retinal detachment is often a real threat if the retinal angiomas are left untreated. The aim of this trial was to diagnose and treat capillary angiomas early at an asymptomatic stage.

METHODS

Since 1983, we have investigated patients with key lesions and those who are at risk for VHL in a multidisciplinary study. Classical retinal angiomas and microangiomas were treated with the Argon laser. Checks during a follow-up of 15 years have provided us with long-term results.

RESULTS

We detected 189 retinal angiomas in 97 eyes of 69 patients (105 classical angiomas, including 19 fibrotic angiomas in 15 eyes, 84 microangiomas). During the study, 20 patients (twenty-one symptomatic eyes) entered the study already with a visual impairment. Sixty asymptomatic eyes from 49 patients with a total of 108 retinal angiomas (55 microangiomas and 53 classical angiomas) were treated by us with photocoagulation. Nineteen asymptomatic eyes with angiomas of fibrotic type were observed only. During a mean follow-up of 5.1 years (range: 0.25 - 15; SD: 3.88) observed after treatment, no deterioration of vision occurred in 37 patients treated with photocoagulation. Regular controls showed 5 relapsing angiomas and 9 new angiomas which were successfully coagulated again. New angiomas occurred in those eyes with several angiomas as a predisposition. Patients with a tendency to multiple angiomas need to be seen more frequently because these eyes have a high risk of becoming blind, even in already coagulated angiomas.

CONCLUSION

Laser treatment was successful. Early ophthalmological examination of patients with retinal angiomatosis is a great challenge, since these lesions can only be successfully treated at an early stage. Treatment is then effective and safe, but long-term follow-up is necessary. New angiomas occurred in those eyes with several angiomas as a predisposition.