Therapeutic options for capillary papillary hemangiomas. Discussion

Purpose: To describe the results and therapeutic complications of treatment of papillary capillary hemangiomas over the last 13 years. Design: Retrospective, noncomparative, interventional case series. Participants: Five cases of unilateral capillary papillary hemangiomas were reviewed. Three patients had von Hippel-Lindau disease, and two had no associated familial or systemic disease. Methods: Two patients were treated with argon green laser, one patient received argon green and diode photocoagulation, and two patients underwent argon green photocoagulation and diode transpupillary thermotherapy (TTT); two eyes also underwent vitreoretinal surgery. Follow-up ranged from 1 to 13 years. Main Outcome Measures: The presence of exudative retinal detachment associated with the activity of the hemangioma and the visual acuity were the two main parameters. Results: Prompt argon green laser treatment was the most effective therapy; TTT was ineffective. Vitreoretinal surgery, transscleral drainage, and argon endolaser photocoagulation in one case resolved bullous retinal detachment secondary to tumor exudation. Pretreatment visual acuity (VA) levels ranged from 20/25 to counting fingers; posttreatment VA levels ranged from 20/25 to light perception. Conclusions: If left untreated, papillary hemangiomas may evolve to exudative retinal detachment and marked VA decreases. Although we have not established an ideal therapy, we recommend appropriate treatment on diagnosis. Close follow-up and multiple treatments with argon laser are likely the best therapeutic course.