Combined brachytherapy and vitreoretinal surgery for a large retinal capillary hemangioma with exudative retinal detachment.
INTRODUCTION
We report about a large retinal capillary hemangioma (RCH) with exudative retinal detachment and a macular fold, treated with Ruthenium-106 brachytherapy (Ru-106 BT) and scleral buckling surgery, followed by pars plana vitrectomy (PPV), for the removal of macular tractions.


CASE DESCRIPTION
A 17-year-old boy was referred to our Ocular Oncology Unit for a large RCH in the left eye. BCVA was hand motion. The RCH measured 4.9 × 6.85 mm in basal diameters and 4.0 mm in thickness and was located in the mid-peripheral temporal retina. It was surrounded by extensive subretinal exudation, forming an exudative retinal detachment, with a retinal fold that extended from the lesion to the optic disc. We performed Ru-106 BT and at the moment of the plaque removal we placed a radial buckle with the aim to unbend the retinal fold. At 3-months follow-up the exudation decreased, we achieved the opening of the peripheral side of the retinal fold, but the macula was still detached. We decided to perform a lens sparing PPV, macular peeling and air tamponade, to remove the vitreoretinal tractions ab interno and to try to complete the opening of the macular fold. After 1-month BCVA was counting fingers, the retina appeared attached, also in the macular area, but the retinal fold remained partially close in the macular side. After 6 months the tumor was inactivated, the macula remained attached, unfortunately, the macular fold remained partially close.


CONCLUSION
Ru-106 BT and scleral buckling concurrent approach can be an effective treatment modality in selected cases of large RCHs, followed by PPV to remove eventual vitreo-retinal tractions.
['Barca|Francesco|F|https://orcid.org/0000-0001-8835-9381', 'Vicini|Giulio|G|https://orcid.org/0000-0001-7646-7422', 'Nicolosi|Cristina|C|', 'Pieretti|Giulia|G|', 'Caporossi|Tomaso|T|https://orcid.org/0000-0002-6902-2983', 'Rizzo|Stanislao|S|', 'Giansanti|Fabrizio|F|', 'Mazzini|Cinzia|C|']
D000293:Adolescent D001918:Brachytherapy D018324:Hemangioma, Capillary D006801:Humans D008297:Male D012163:Retinal Detachment D012189:Retrospective Studies D012591:Scleral Buckling D014792:Visual Acuity D014821:Vitrectomy D057586:Vitreoretinal Surgery
brachytherapy vitreoretinal surgery Retinal capillary hemangioma retinal detachment