Open Journal of Ophthalmology, 2012, 2, 5-7
http://dx.doi.org/10.4236/ojoph.2012.21002 Published Online February 2012 (http://www.SciRP.org/journal/ojoph) 5
Another Proliferative Diabetic Retinopathy? A Case
Report of Retinal Cavernous Haemangioma Treated
with Intravitreal Bevacizumab, Initially Labelled as
Persistent Proliferative Diabetic Retinopathy
Myrto Tsagkataki1*, Ahmad Khalil1, Ahmed Kamal1
1Ophthalmology Department, Aintree University Hospitals, Liverpool, United Kingdom.
Received November 19th, 2011; revised December 24th, 2011; accepted January 25th, 2012.
ABSTRACT
We present a case of Retinal Cavernous Haemangioma treated with Intravitreal Bevacizumab, which was initially la-
belled as persistent proliferative diabetic retinopathy with multiple episodes of v itreous haemorrhage. These lesions can
be confused with new retinal vessels in diabetics and if correctly diagnosed unnecessary photocoagulation can be
avoided. Our patient received a course of three intravitreal Bevacizumab injections (1.25 mg/0.05 ml) in order to stop
the leakage from the retinal cavernous haemangioma lesions and prevent another episode of vitreous haemorrhage. No
intraoperative or postoperative complications were seen. Twenty-two months following treatment there was no recur-
rence of vitreous haemorrhage.
Keywords: Retinal Cavernous Haemangioma; Intravitreal Bevacizumab; Persistent Proliferative Diabetic Retinopathy;
Vitreous Haemorrhage
1. Introduction
We would like to report a case of Retinal Cavernous
Haemangioma treated with Intravitreal Bevacizumab,
which was initially diagnosed as persistent proliferative
diabetic retinopathy with multiple episodes of vitreous
haemorrhage.
2. Case
A 59 year-old insulin dependent diabetic male was re-
ferred from another ophthalmic unit with a diagnosis of
persistent retinal neovascularisation in the left eye, de-
spite repeat sessions of laser photocoagulation. He had a
history of multiple mild to moderate self-limiting vitre-
ous haemorrhages in the past which settled without any
surgical intervention. Previous medical history apart
from diabetes mellitus was insignificant. On examination
Best-Corrected Visual Acuity (BCVA) was logMAR
0.00 OD and 0.18 OS. Anterior segment examination
was unremarkable. Fundus exa mination showed a cluster
of abnormal vessels in the juxtapapillary region of the
temporal retina (Figure 1(a)). Fluorescein Angiography
(FFA) showed saccular lesions with slow filling in the
early phase and late hyperfluorescence with typical fluid
levels within the saccules (Figure 1(b)).Optical Coher-
ence Tomography (OCT) showed a bunch of “gr a pe-l i ke” ,
nodular retinal lesions proliferating to the posterior hya-
loid space (Figure 1(c)). The working diagnosis was
Retinal Cavernous Haemangioma. MRI brain and orbit
was then performed which didn’t show any abnormalities.
A decision was made to treat the patient with a view to
shrink these lesions and prevent a recurrence of vitreous
haemorrhage. The patient received monthly intravitreal
injections of Bevacizumab (1.25 mg/0.05 ml) for three
months. At the last follow up, 22 months following treat-
ment, BCVA remained logMAR 0.18 OS. The lesions
showed demonstrable decrease in dimensions and no
leakage on FFA (Figures 2). During that period the pa-
tient develop no further episodes of vitreous haemor-
rhage.
3. Discussion
Cavernous haemangiomas of the retina are believed to be
rare congenital vascular hamartomas and may present
commonly as an incidental finding or rarely as a cause of
vitreous haemorrhage [1]. Histologically, these vascular
alformations have normal endothelial cells and support- m
*Corresponding a uthor.

Another Proliferative Diabetic Retinopathy? A Case Report of Retinal Cavernous Haemangioma Treated with
Intravitreal Bevacizumab, Initially Labelled as Persistent Proliferative Diabetic Retinopathy
6
(a) (b) (c)
Figure 1. (a) Colour photo of left fundus showing “grape like” lesions temporal to the optic disc (arrows); (b) Fluorescein
Angiogram in midphase showing leakage and hyperfluorescent menisci of the juxtapapillary lesions (arrows); (c) OCT
showing retinal nodular lesions proliferating to the posterior hyaloid space (arrow).
(a) (b) (c)
Figure 2. Twenty two months following treatment (a) Colour photo showing decrease in number and size of lesions (arrow);
(b) Fluorescein Angiogram showing no leakage; (c) OCT showing no vascular proliferation to the posterior hyaloid space and
significant shrinkage of lesions (arrow).
ing fibrous septa and therefore have less likelihood of
leakage but may occasionally rupture and cause vitre-
ous haemorrhage. They are often sporadic but familial
bilateral cases have been reported [2]. In some patients,
these tumours have been observed to co exist with intrac-
ranial cavernous haemangioma and angiomatous skin
lesions [3,4]. It has been reported that 5% of the patients
diagnosed with cerebral haemangioma have associated
retinal cavernous haemangiomas [2]. Therefore the oph-
thalmologist plays a critical role in accurate and early
diagnosis. Ophthalmoscopically, retinal cavernous hae-
mangioma appears as a group of blood-filled saccules
within the inner retinal layers. Relevant diagnostic tests
include Fluorescein angiography and Optical coherence
tomography (OCT). Patients may be asymptomatic in
which case no treatment is necessary. However visual
acuity can deteriorate due to accompanying epiretinal
membrane or vitreous haemorrhage where vitrectomy
may be needed [1]. In our patient the decision to treat the
lesions with intravitreal Bevacizumab was taken in view
of the risk of recurrent vitreous haemorrhage, as they
were leaking on FFA. Following the treatment, the size
and number of the retinal lesions reduced and the leakage
disappeared with no recurrence of vitreous haemorrhage
at last follow up.
4. Conclusion
In conclusion, we would like to stress the significance of
identification of these lesions, which can be confused,
with new vessels of diabetic retinopathy and lead to un-
necessary photocoagulation. Furthermore, to the best of
our knowledge this is the first case report where in-
travitreal Bevacizumab has been used for the treatment
of retinal cavernous haemangioma.
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Another Proliferative Diabetic Retinopathy? A Case Report of Retinal Cavernous Haemangioma Treated with
Intravitreal Bevacizumab, Initially Labelled as Persistent Proliferative Diabetic Retinopathy 7
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