Advances in treatment of retinal angiomas

Retinal angiomas are benign vascular hamartomatous lesions with important systemic and visual implications. Early diagnosis and treatment of retinal angiomas with an appropriate systemic workup for associated systemic diseases can prevent visual loss and morbidity and mortality. Tumors less than 3 mm in diameter usually can be ablated with laser photocoagulation. Cryotherapy should be reserved for eyes in which media opacities prohibit use of the laser or the tumor is located in an area of shallow serous detachment or in the extreme peripheral retina. Macular puckers or tractional macular detachments caused by retinal angiomas can be treated effectively by pars plana vitrectomy combined with photocoagulation or cryotherapy to the retinal angioma. Penetrating diathermy is a useful alternative therapy for large tumors but is fraught with risks of hemorrhage and inadvertent retinal breaks with or without vitreous loss or retinal detachment. We have found proton-beam irradiation to be an efficacious and safe treatment for large retinal angiomas (> 3 mm) and for cases complicated by exudative retinal detachments or for tumors involving the optic nerve. We believe this new, noninvasive therapy is a significant advance in the treatment of complicated retinal angiomas or for those tumors that have failed to respond to conventional measures.