Isolated juxtapapillary haemangioma

Purpose To report a case of a juxtapapillary retinal capillary haemangioma Methods A 21‐year‐old lady was referred from her optician with a six month history of blurred vision in her right eye. She was otherwise fit and well and did not take any regular medication. She had experienced occasional migraines in the last few years. She had no significant family history of note. On presentation, her visual acuity was 6/6 in both eyes. She had evidence of right optic disc swelling with some telangiectatic changes in a peripapillary distribution. In addition there were significant hard exudates temporal to the macula. A fundus fluorescein angiogram and OCT were undertaken which were consistent with a juxtapapillary capillary haemangioma. Although she had no systemic symptoms suggestive of Von Hippel‐Lindau (VHL) syndrome, we referred her to a clinical geneticist to initiate investigations to evaluate this, as retinal haemangiomas are a frequent presenting feature of VHL; although they can be an isolated disorder. She underwent an abdominal and pelvic USS which was reported as normal, MRI of the head was reported as revealing no features suggestive of VHL disease, FBC, U&Es were also normal, 24 hr urine collection was normal for adrenaline, nor‐adrenaline and dopamine. Results Sixteen months after her first visit, her vision dropped to 6/12. OCT imaging demonstrated increasing macular oedema and exudation over the fovea. It was decided that the best option for treatment was intravitreal avastin, in combination with photodynamic therapy. Conclusion Combined anti‐VEGF therapy and PDT are a treatment option for juxtapapillary capillary haemangioma; although prognosis is often poor.