5. • History of present illness:
Gradual, painless central loss of vision progressing
to the periphery for one year in right eye.
Associated with the floaters.
6. • Past Medical & Surgical history:
Not significant
• Past ocular history:
Far glasses: 2 years.
7. • Family history:
Father and paternal uncle died of brain tumor
Grand father died of abdominal tumor.
8. • Personal history:
• Student of B.Sc software engineering
• Unmarried
• Socioeconomic history:
Middle class family
23. DIAGNOSIS
• Bilateral Retinal Capillary Hemangiomas with Exudative Retinal
detachment in the right eye
• VON HIPPEL-LINDAU syndrome.
24. TREATMENT:
• Oral steroids 1mg per kg body weight for 10 days.
• Right eye: Argon laser photocoagulation was performed
• Left eye: Argon laser photocoagulation was performed
• Consult Neuro-surgeon, General surgeon , physician and
Oncologist.
32. RECOMMENDED FOLLOW UP
PROTOCOL OF PATIENT*
• Annual physical examination
• Annual comprehensive fundus examination.
• Magnetic resonance imaging of brain and spinal cord every 3 years
to age 50 years and every 5 years thereafter.
• Annual renal ultrasound scan, with computed tomography scan
every 3 years and more frequently if multiple renal cysts are
present.
• Annual 24 hour urine collection of vanilylmandelic acid.
*Myron Yanoff and Jay S. Duker. Ophthalmology 4th Ed
33. SCREENING PROTOCOL OF AT RISK
RELATIVES*
• Annual physical examination.
• Annual comprehensive fundus examination from age 5 years.
• Magnetic resonance imaging of brain and spinal cord every 3 years
from age 15 to 50 years until age 60 years.
• Annual renal ultrasound scan, with computed tomography scan
every 3 years from the age 20 through 65 years.
• Annual 24 hour urine collection for vanillylmandelic acid.
*Myron Yanoff and Jay S. Duker. Ophthalmology 4th Ed
34. VON HIPPEL LINDAU SYNDROME
• It is a autosomal dominant condition which is characterized by
visceral cysts and benign tumors in multiple organ systems that
have subsequent potential for malignant change.
37. PROGNOSIS
• Progression of retinal capillary hemangiomas in VHLS is highly
variable because of complications.
• Ophthalmic treatment is usually able to preserve good vision in
at least one eye.
• Cause of death intracranial and renal tumors.
• The median age at death in patients who have VHLS is 45–50
years .