Treatment of tuberous sclerosis complex-associated retinal astrocytic hamartoma complicated with vitreous hemorrhage

Three cases of tuberous sclerosis complex (TSC)-associated retinal astrocytic hamartomas (RAH) complicated with vitreous hemorrhage were presented in this report. The first patient received sirolimus monotherapy. The lipid exudation was absorbed gradually, but there remained some stable exudative masses around the macula covered by epiretinal membranes. The second case was treated with vitrectomy, followed by sirolimus and intravitreal anti-vascular endothelial growth factor (VEGF) treatment. The exudates were absorbed, and the tumor remained stable afterward. The third patient was initially treated with vitrectomy combined with anti-VEGF treatment, but vitreous hemorrhage re-occurred soon after the surgery. He was then treated with sirolimus, and the tumor remained stable afterwards without further recurrence. From experience of treating these three patients, we suggested that for TSC-RAH complicated with vitreous hemorrhage, vitrectomy in combination with sirolimus is suggested to be the better choice. Intravitreal anti-VEGF injection is a supplementary treatment.