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.