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SM Michels, U Schmidt-Erfurth; Photodynamic Therapy in Large Choroidal Hemangioma: Along-term Evaluation . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1833.
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Purpose:To document the anatomical and functional outcome of photodynamic therapy (PDT) in choroidal hemangioma over a long-term follow-up. Methods:A prospective, non comparative, interventional case series is presented. 15 consecutive patients with circumscribed choroidal hemangioma of the posterior pole demonstrating presenting with progressive vision loss were included. PDT using 6 mg/m2 body surface area verteporfin and a light dose of 100 J/cm2 at 692 nm was performed. One to four laser treatment were applied in 6 week intervals as a single spot. A standardized evaluation was provided prior to and at 6 weeks intervals after each treatment, at 3, 6 and 12 months, and a mean follow-up of 19 months. Functional tests included best refracted EDTRS VA and scanning laser scotometry, anatomical results were documented by ophthalmoscopy, fluorescein (FA)/ indocyanine green angiography (ICGA) and ultrasound. Results:A complete regression of the vascular mass was achieved in all eyes, following one to four consecutive treatments. Tumors (mean height 3.8 mm) responded with a reproducible decrease in size to each treatment. The most intensive reduction in prominence was found after the first PDT course (1.5 mm mean decrease), a continous, but less impressive flattening (by a mean of 0.6 mm) was seen after subsequent treatments. Occlusion of the angiomatous net without recanalization was documented angiographically. Two patients remained stable in ETDRS vision with resolution of metamorphopsia, 13 showed substantial visual recovery. VA improvement of an average of 3 lines was documented with a mean VA level of 20/125 pretreatment and 20/80 post therapy. Vision improvements ranged between 1 and 8 lines. Visual fields showed improvements in all eyes with withdrawel of central scotomas. Photoreceptor recovery was also seen in eyes with direct infiltration of the fovea by the tumor mass. Conclusion:PDT using verteporfin offers a safe and effective option to treat choroidal hemangiomas. Complete anatomical regression is associated with substantial improvement in visual acuity and central visual fields.
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