Retinal hemangioblastomas are the most common manifestation of Von Hippel-Lindau (VHL) disease [1-3]. While peripheral
retinal hemangioblastomas may be treated by thermal
laser treatment or
cryotherapy, optic nerve and macular lesions are more difficult to treat [4, 5]. Based on the theoretical benefit of administering anti-
VEGF treatment, intra-vitreally administered
bevacizumab (
Avastin, a general pan-
VEGF inhibitor) is attractive [6, 7]. Several short-term case series using
ranibizumab (
Lucentis, mAb fragment of
bevacizumab with stronger affinity for
VEGF-A) have shown it has promising but minimal success on most VHL-related
hemangioblastomas [8, 9]. A comprehensive study by Wong et al. examined 5 patients over a period up to 61 weeks (47 ± 14 weeks) while Michels et al. examined one patient over a period of 4 months. Due to the short-term nature of these studies, we attempted long-term
bevacizumab treatment over 60 months in a monocular subject with progressive visual loss due to a VHL associated macular and optic nerve
hemangioblastoma. Over the treatment regimen of 15
injections, visual acuity improved 25 letters, OCT thickness improved from 646 um to 424 um, and structural lesions stabilized while exudates and
edema resolved.