CLINICOPATHOLOGICAL CORRELATION OF ARGON-LASER PHOTOCOAGULATION OF RETINAL ANGIOMAS IN A PATIENT WITH VONHIPPEL-LINDAU DISEASE FOLLOWED FORMORE THAN 20 YEARS

Purpose: The authors review the histopathologic findings in the eyes o f a patient with multiple retinal angiomas and von Hippel-Lindau disea se, who underwent treatment with argon laser photocoagulation with fol low-up of more than 20 years. Methods: The patient was studied ophthal moscopically and by fluorescein angiography before and after argon las er photocoagulation of retinal angiomas. The eyes were obtained postmo rtem, and the central portion of the right eye, including the macula a nd optic nerve head, was sectioned serially for light microscopy. The pupil-optic nerve segment of the left eye was step-sectioned serially for light microscopy. Results: Histopathologic study of the right eye disclosed mild cystoid macular edema and focal areas of exudation in t he midperiphery possibly secondary to irradiation of the head. A 1.5 x 0.3-mm area of residual angioma was present in the nasal peripapillar y retina. Superotemporally, four chorioretinal scars were present in o ne photocoagulated area. These scars were composed of dense fibrous ti ssue with vascularization and variable retinal pigment epithelium hype rplasia. Large, nonangiomatous vessels within each of the scars were c ontinuous with other retinal vessels. Inferotemporally, two chorioreti nal scars were present in one photocoagulated area. Histopathologicall y, these scars were similar to the superotemporal scars, except that n o patent retinal vessels traversed the inferotemporal scars. Neovascul arization of the retina was associated with one superotemporal and one inferotemporal scar. No residual angiomatous tissue was present in th e supero- or inferotemporal areas. Histopathologic examination of the left eye disclosed extensive vitreous organization and periretinal fib rovascular proliferation, extensive gliosis of the retina, and a 4.5 X 2-mm schisis cavity filled with fibrinous exudate. Three angiomas wit h variable fibrosis were present in the left eye. Conclusion: Despite a poor clinical course in one eye treated with xenon are photocoagulat ion, trans-scleral diathermy, and argon laser photocoagulation, a pati ent with von Hippel-Lindau disease and multiple retinal angiomas retai ned good vision in the other eye after successful treatment with argon laser photocoagulation with follow-up of more than 20 years, The amou nt of regression of angiomatous tissue after photocoagulation varied f rom lesion to lesion (complete in some; minimal in others). The author s conclude that argon laser photocoagulation of early lesions is effec tive in ablating smaller (less than or equal to 3-disc diameter) retin al angiomas.