THE ROLE OF BRACHYTHERAPY IN THE TREATMENT OF RETINAL CAPILLARY HEMANGIOMAS

Purpose: to evaluate the efficiency of brachytherapy treatment in capillary retinal hemangioma and the emerging complications. Material and methods. Between 2005 and 2014, 18 patients with capillary hemangioma of the retina (11 females and 7 males, mean age 29 ± 13.9 years) were treated, 8 patients had monocular and 10 patients had binocular lesion. In 12 cases, capillary hemangioma of the retina was associated with Hippel - Lindau disease, in 6 cases a sporadic tumor appeared. 90Sr and 106Ru ophthalmic applicators were used. In 7 eyes, brachytherapy was preceded by laser coagulation. After local irradiation, the patients were followed up for 1 month to 3 years. Results. The pathological process was stabilized in 13 eyes. 5 eyes, no later than 3 months after the procedure, developed a severe radiation reaction, total retinal detachment, and recurrent hemophthalmos, which later, after 6 months or more, led to the development of neovascular glaucoma. In one case, the eye had to be enucleated due to terminal painful glaucoma. In 3 eyes despite tumor regression, retinal detachment persisted over the follow-up period, although the macular area remained unaffected. Complicated cataract (12 eyes), neuroretinopathy (2 eyes), appearance of new capillary hemangiomas (1 eye), increased epiretinal fibrosis (4 eyes), and secondary central chorioretinal dystrophy (2 eyes) were observed over the period of up to 2 years. Conclusion. In most cases, brachytherapy of retinal capillary brings about a satisfactory anatomical result. However, in order to reduce postoperative complications and improve the functional result, a thorough preoperative selection of patients is needed, which should take into account the initial retinal status. For citation: Neroev V.V., Saakyan S.V., Ilyukhin P.A., Valskiy V.V., Ryabina M.V., Novikova A.Yu. The role of brachytherapy in the treatment of retinal capillary hemangiomas. Russian ophthalmological journal. 2018; 11 (3): 5-10 (In Russian). doi: 10.21516/2072-0076-2018-11-3-5-10

капиллярная гемангиома сетчатки, болезнь Гиппеля-Линдау, брахитерапия, отслойка сетчатки, retinal capillary hemangioma, von Hippel - Lindau disease, brachytherapy, retinal detachment

1. Sanfilippo P., Troutbeck R., Vandeleur K. Retinal angioma associated with von Hippel-Lindau disease. Clinical and Experimental Optometry. 2003; 86: 187-191. doi:10.1111/j.1444-0938.2003.tb03102.x

2. Latif F., Tory K., Gnarra J., et al. Identification of the von Hippel-Lindau disease tumor suppressor gene. Science. 1993; 260: 1317-20. doi:10.1126/science.8493574

3. Singh A.D., Shields C.L., Shields J.A. von Hippel-Lindau disease. Surv. Ophthalmol. 2001; 46 (2): 117-42. https://doi.org/10.1016/S0039-6257(01)00245-4

4. Chew E.Y. Ocular manifestations of von Hippel-Lindau disease: clinical and genetic investigations. Trans. Am. Ophthalmol. Soc. 2005; 103: 495-511.

5. Lonser R.R., Glenn G.M., Walther M. et al. von Hippel-Lindau disease. Lancet. 2003; 361 (9374): 2059-67. https://doi.org/10.1016/S0140-6736(03)13643-4

6. Webster A.R., Maher E.R., Moore A.T. Clinical characteristics of ocular angiomatosis in von Hippel-Lindau disease and correlation with germ line mutation. Arch. Ophthalmol. 1999; 117(3): 371-8. doi:10.1001/archopht.117.3.371

7. Chan C.C., Chew E.Y., Shen D., Hackett J., Zhuang Z. Expression of stem cells markers in ocular hemangioblastoma associated with von Hippel-Lindau (VHL) disease. Mol Vis. 2005; 11: 697-704.

8. Neumann H.P., Wiestler O.D. Clustering of features of von Hippel-Lindau syndrome: evidence for a complex genetic locus. Lancet. 1991; 337 (8749): 1052-54. https://doi.org/10.1016/0140-6736(91)91705-Y

9. Webster A.R., Maher E.R., Bird A.C., Gregor Z.J., Moore A.T. A clinical and molecular genetic analysis of solitary ocular angioma. Ophthalmology 1999; 106 (3): 623-9. https://doi.org/10.1016/S0161-6420(99)90127-6

10. Huang C., Tian Z., Lai K. et al. Long-term therapeutic outcomes of photodynamic therapy-based or photocoagulation-based treatments on retinal capillary hemangioma. Photomed. Laser Surg. 2018; 36(1): 10-7. doi:10.1089/pho.2017.4296

11. Koen S-I., Kvintel' G. Fluorescence angiography in the diagnosis of fundus pathology. Neroev V.V., Ryabina M.V., eds. Moscow: Reytar; 2005. (in Russian).

12. Singh A.D., Nouri M., Shields C.L. et al. Treatment of retinal capillary hemangioma. Ophthalmology. 2002; 109: 1799-806. http://dx.doi.org/10.1016/S0161-6420(02)01177-6

13. Suh C.S., Jin S.Y., Bae S.H., Kim C.G., Kim J.W. Retinal capillary hemangioma treated with verteporfin photodynamic therapy and intravitreal triamcinolone acetonide. Korean J. Ophthalmol. 2007; 21(3): 178-84. https://doi.org/10.3341/kjo.2007.21.3.178

14. Gauthier D., D’Amico D.J., Mukai S. von Hippel-Lindau disease. Int. Ophthalmol. Clin. 2001; 41: 173-87.

15. Schmidt D., Natt E., Neumann H.P. Long-term results of laser treatment for retinal angiomatosis in von Hippel-Lindau disease. Eur. J. Med. Res. 2000; 5(2): 47-58.

16. Blodi C.F., Russell S.R., Pulido J.S., Folk J.C. Direct and feeder vessel photocoagulation of retinal angiomas with dye yellow laser. Ophthalmology. 1990; 97(6): 791-7. doi:10.1016/S0161-6420(90)32509-5

17. Kreusel K.M., Bornfeld N., Lommatzsch A., Wessing A., Foerster M.H. Ruthenium-106 brachytherapy for pe ripheral retinal capillary hemangiomas. Ophthalmology. 1998; 105(8): 1386-92. https://doi.org/10.1016/S0161-6420(98)98017-4

18. Саакян С.В., Пантелеева О.Г., Ширина Т.В. Оценка выживаемости больных увеальной меланомой после органосохранного лечения и энуклеации. Российский офтальмологический журнал. 2011; 4(1): 67-70.

19. Stannard C., Sauerwein W., Maree G., Lecuona K. Radiotherapy for ocular tumors. Eye. 2013; 27(2): 119-27.

20. Shields C.L., Shields J.A., Cater J. et al. Plaque radiotherapy for uveal melanoma: long - term visual outcome in 1106 consecutive patients. Arch. Ophthalmol. 2000; 118: 1219-28. doi:10.1001/archopht.118.9.1219

21. Shields C.L., Shields J.A., De Potter P. et al. Plaque radiotherapy in the management of retinoblastoma. Use as a primary and secondary treatment. Ophthalmology. 1993; 100(2): 216-24. https://doi.org/10.1016/S0161-6420(93)31667-2

22. Anastassiou G., Bornfeld N., Schueler A.O. et al. Ruthenium-106 plaque brachytherapy for symptomatic vasoproliferative tumours of the retina. Br. J. Ophthalmol. 2006; 90(4): 447-50. https://doi.org/10.1136/bjo.2005.081422

23. Turaka K., Turaka A., Koneru B.N. Role of radiation therapy for choroidal hemangioma: a brief review. J. Clin. Res. Ophthalmol. 2016; 3(1): 18-22. doi: 10.17352/2455-1414.000030

24. Kreusel K.M., Bornfeld N., Lommatzsch A., Wessing A., Foerster M.H. Ruthenium-106 brachytherapy for peripheral retinal capillary hemangioma. Ophthalmology. 1998; 105(8): 1386-92. https://doi.org/10.1016/S0161-6420(98)98017-4

25. Russo V., Stella A., Barone A., Scott I.U., Noci N.D. Ruthenium-106 brachytherapy and intravitreal bevacizumab for retinal capillary hemangioma. Int Ophthalmol. 2012; 32(1): 71-5. doi: 10.1007/s10792-011-9513-1

26. Balázs E., Berta A., Rózsa L., Kolozsvári L., Rigó G. Hemodynamic changes after Ruthenium irradiation of Hippel's angiomatosis. Ophthalmologica. 1990; 200: 128-132. doi: 10.1159/000310093

27. Grossniklaus H.E., Thomas J.W., Vignesavaran N., Jarrett W.H. Retinal hemangioblastoma: a histologic, immunohistochemical, and ultrastructural evaluation. Ophthalmology 1992; 99 (1): 140-145. https://doi.org/10.1016/S0161-6420(92)32024-X