Epipapillary isolated astrocytoma associated with branch retinal artery occlusion in a single eye

Abstract

As the patient had new VH and persistent leakage from NVD after aggressive PRP, he was offered intravitreal bevacizumab OD, after a full discussion of its off-label nature and potential risks. Using a sterile protocol, 4 0.05 cc (1.25 mg) of bevacizumab was injected intravitreally OD.One week later, vision measured 20/25 þ 2 OD, the VH had cleared, and the NVD appeared fibrotic OD. Fluorescein angiography (Figure 2) showed dramatic regression and cessation of leakage from NVD. CommentThis case illustrates rapid cessation of leakage from NVD 1 week following adjunctive intravitreal bevacizumab. Although it may be argued that PRP caused regression of NVD, examination and fluorescein angiography 5 weeks after PRP showed new VH and persistent leaking NVD, which stopped leaking 1 week after intravitreal bevacizumab. As PRP is the standard of care for high-risk PDR, 5 it was only after maximal PRP that we offered the patient off-label adjunctive treatment. Further studies are needed to determine the role of bevacizumab in the management of PDR. References

Retinal astrocytic hamartoma complicated by branch retinal vein occlusion in a patient with tuberous sclerosis complex

“…An eye with an epipapillary astrocytic hamartoma was reported to have a branch retinal artery obstruction (BRAO). 23 …”

“…As Vedantham et al also mentioned in their BRAO study, the pathophysiology of venous blockage in our case may be owing to increased resistance and therefore delayed circulation in draining veins, which increases the likelihood of vascular obstruction. 23 Endothelial damage of tumor vasculature may result in thrombosis, and vascular blockage may ensue due to increased hydrostatic pressure in the retinal veins in the astrocytic hamartoma region, according to a second proposed explanation. 24 …”