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Enrico Bertelli, Michael Simonazzi; Indocyanine green-mediated Photothrombosis in the treatment of Vasoproliferative Retinal Tumors: a case series.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3093.
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To assess the efficacy of indocyanine green-mediated photothrombosis (ICGMP) in the treatment of Vasoproliferative Retinal Tumors (VPRT) with various size and clinical expression. Lesions were all peripheral and symptomatic, due to associated manifestations at the level of retina and/or vitreous.
Retrospective, consecutive case series. 4 consecutive patients, 2 males, 2 females, aged 39 to 62 years, presenting unilateral, single VPRT lesions of variable size (1,5 to 7 mm maximum diameter) underwent ICGMP at our institution. Late pooling or staining of ICG dye within the lesion was considered an essential prerequisite for the treatment. Thirty minutes after the administration of a loading dose of 1 mg/kg of intravenous ICG multiple, confluent, 2 mm wide, infrared 810 nm diode laser spots were applied on the surface of the tumors. The final number of spots applied were related to the tumor size. Duration of each spot was up to 60 sec., with power between 400 and 1200 mW. Pain perception by the patient during treatment was used as limit for the single laser exposure. Diode laser power was increased until pain threshold was reached, starting at 300 mW.
No change in tumor aspect was observed during and immediately after treatment. ICG late images were taken after treatment, showing no hyperfluorescence of the lesion in all cases. In 2 cases 2 treatments were sufficient to obliterate the lesion. In the remaining 2 cases 3 and 4 treatments respectively were necessary, in order to achieve a complete destruction of the lesion. In 2 cases an associated vitreoretinal interface disorder (stage 3 macular hole) underwent successful vitreoretinal surgery 2 to 3 months after treatment of the VPRT lesion. Visual acuity improved in 3 cases and remained stable in 1 case, in which faint vitreous hemorrhage was present at first observation, with patient retaining full vision. All lesion regressed to fibrotic and partly pigmented scars.
In the reported case series (4 eyes of 4 patients) ICGMP achieved complete obliteration of single VPRT lesions of different size (1,5 to 7 mm). Significant improvement or stabilization of function was achieved in all cases. ICGMP is less invasive than cryotherapy and less expensive than Photodynamic Therapy. It may deserve further attention in the treatment of selected retinal vascular tumors characterized by late ICG pooling or staining.
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