Endocryotherapy is a good treatment option for patients with larger retinal angiomatous tumors.
Reviewed by Colin A. McCannel, MD, FACS, FRCS(C)
Take-home: Endocryotherapy is a good treatment option for patients with larger retinal angiomatous tumors.
Transvitreal endocryotherapy can be a reasonable option for the treatment of larger retinal angiomatous tumors.
Colin A. McCannel, MD, FACS, FRCS(C), professor of clinical ophthalmology and medical director, Stein Eye Institute, Department of Ophthalmology, David Geffen School of Medicine at UCLA, outlined how endocryotherapy can be a treatment for retinal hemangioblastoma.
He presented the case of a 25-year-old, white female patient with a peripheral hemangioblastoma.
“External cryotherapy had been tried on several occasions by the referring ophthalmologist without achieving tumor control,” Dr. McCannel said.
Dr. McCannel decided to treat the patient with a vitrectomy and internal cryotherapy. The patient presented with an angioma and dilated arcade vessels that lead up to it.
After enlargement of the sclerotomy, the hemangioblastoma was treated with a freeze-thaw-freeze technique. Dr. McCannel briefly discussed follow-ups at 13 months and 23 months, noting that the patient had an excellent result without retinal detachment development, either serous or rhegmatogenous. Furthermore, the dilated vessels had returned to normal size, and the angioma was reduced to a small fibrotic mass.
Evaluating treatment options
There are several potential treatments for hemangioblastoma, although they all have potential downsides, Dr. McCannel said. Laser photocoagulation is best only for small lesions; external cryotherapy is for small- to intermediate-sized lesions but can exacerbate exudation.
Photodynamic therapy with verteportfin has a high rate of reactivation. Plaque brachytherapy is potentially expensive and complicated by radiation retinopathy and endo-resection has a high risk of proliferative vitreoretinopathy.
Endocryotherapy is used to treat hemangioblastomas to minimize freezing damage to the sclera, choroid, and retina, Dr. McCannel said. The surgeons can use intensive treatment, with minimal choroidal irritation and limited exudation and exudative retinal detachment.
“Proliferative retinopathy may be avoidable or minimized by using endocryotherapy as a primary treatment,” Dr. McCannel said.
Colin A. McCannel, MD, FACS, FRCS(C)
Dr. McCannel has financial interests with Dutch Ophthalmic. This article is adapted from a presentation that Dr. McCannel delivered during the 2016 Retina Subspecialty Day prior to the 2016 American Academy of Ophthalmology meeting.