Treatment of juxtapapillary hemangioblastoma by intra-arterial (ophthalmic artery) chemotherapy with bevacizumab

Abstract

PurposeTo report on two cases of treatment-refractory juxtapapillary hemagioblastomas that were managed with intra-arterial bevacizumab delivered via the ophthalmic artery.ObservationsCase 1 is a 35 year-old man with juxtapapillary hemangioblastoma who continued to have progressive tractional retinal detachment, optic nerve neovascaularization and cystoid macula edema (CME) despite heavy prior treatment with intravitreal anti-vascular endothelial growth factor (VEGF) and steroid intravitreal injections and laser. Case 2 is a 41 year-old woman with juxtapapillary hemangioblastoma who had progressive tractional retinal detachment, CME and visually-threatening intraocular pressure elevation despite treatment with anti-VEGF injection and laser. Both cases were treated with three infusions of intra-arterial bevacizumab delivered via the ophthalmic artery. Both tumors demonstrated measurable decrease in height, stability of their secondary retinal changes and minimal requirement for additional treatment at 30 mos and 26 mos follow-up, respectively for cases 1 and 2.Conclusions and importanceThese cases suggest that higher-dose, targeted delivery of anti-VEGF to hemangioblastomas via ophthalmic artery injection may be useful in stabilizing the disease and abating the typical progression of secondary retinal pathology, at least in the first two years after treatment.

3-D OCT angiographic evidence of Anti-VEGF therapeutic effects on retinal capillary hemangioma

“…Francis et al 23 reported two cases of treatment-refractory juxtapapillary RCH managed with intra-arterial infusions of bevacizumab administered through the ophthalmic artery, showing a decrease in height (measured by ultrasonography) of the tumors, and showing stability of treatment effect over two years of follow-up. Wackernagel et al 22 tested systemic bevacizumab in a single patient.…”

Effectiveness of Subconjunctival Bevacizumab Associated With a Laser - Based Procedure in the Treatment of Neovascular Glaucoma

“…Using anti-vascular endothelial growth factor agents such as bevacizumab, the existing neovascularisation can be directly targeted [8]. Bevacizumab binds to vascular endothelial growth factor (VEGF), the key factor of vasculogenesis and angiogenesis, and, by consequence, inhibits the bind of VEGF to its receptors Flt -1 (R-VEGF1) and KDR (R-VEGF2), at the surface of endothelial cells [1,3,5]. Taking into account that intravitreal injections may be complicated by further IOP elevation in patients with NVG, we performed the bevacizumab injections subconjunctivally [4,6].…”