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E. Midena, E. Pilotto, P.P. Radin, V. de Belvis; Bolus vs Standard Photodynamic Therapy in the Treatment of Circumscribed Choroidal Hemangioma: a Randomized, Masked Study. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3154.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To analyze clinical and angiographic (indocyanine green angiography, ICGA) behaviour of circumscribed choroidal hemangioma (CCH) treated with different photodynamic therapy (PDT) regimens. Methods: Twelve consecutive symptomatic patients affected by CCH underwent PDT treatment of their lesion. PDT was randomly performed with two different treatment modalities: standard PDT treatment (verteporfin 6 mg/sqm; 30 ml IV in 10 min; treatment at 15 min; 50 J/sqcm; 83 sec) and bolus PDT treatment (verteporfin 6 mg/sqm; IV bolus in 2 min; treatment at 5 min; 100J/sqcm; 166 sec) . ICGA was performed pre–op, and: 10 minutes, 1 day, 1 and 4 weeks, and every 3 months post–op. Best corrected visual acuity (BCVA; ETRDS chart), fundus photography, microperimetry, OCT and ultrasonography were performed at each follow–up examination. Examiners were masked about PDT regimen.Results: Five patients were treated with standard PDT and seven with bolus regimen. Minimun follow–up was 8 months. One single treatment was performed in each patient. BCVA improved from one to four lines with both PDT treatment regimens, without significant difference between two groups. Microperimetry showed better long term retinal sensitivity over standard treated tumors ( p < .05) Subretinal fluid reabsorbed in all treated eyes. CCH flattened in both treatment groups, faster in bolus treated eyes. ICGA documented a massive involvement of choroidal circulation with PDT bolus, and progressive disappearance of pre–op characteristics in both treatment groups. Reactive pigment epithelium hyperplasia was signicantly more evident in the bolus PDT treated eyes (p< .005). Conclusions: The management of CCH should critically consider long term side effects of any proposed modality. PDT seems to be a promising and safe modality for the treatment of symptomatic CCH, but long term effects of PDT on normal (and neoplastic) choroidal circulation, retinal pigment epithelium and retinal sensitivity need to be adequately considered.
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