Photodynamic Therapy of Circumscribed Choroidal Hemangiomas

Abstract

Abstract: : Purpose: To describe treatment parameters, visual outcome, and tumor control of eleven symptomatic circumscribed choroidal hemangiomas managed with photodynamic therapy (PDT) and verteporfin. Methods: Retrospective, noncomparative, interventional case series of eleven eyes undergoing PDT with verteporfin for symptomatic choroidal hemangiomas. Outcome parameters included visual acuity, tumor height, and clinical findings. Results: Photodynamic therapy was performed once in 9 eyes and twice in 2 eyes. Durations of laser exposure were 83 seconds (5 eyes), 166 seconds (5 eyes), and 289 seconds (1 eye). After a mean follow-up of 8 months (range, 2-20 months), mean visual acuity improved from 20/200 (range, 20/40-5/200) preoperatively to 20/40 (range, 20/15 - 5/200) postoperatively (p<0.05, paired two-tailed t-test). Average tumor height decreased from 2.3mm (range, 0.9mm - 3.1mm) preoperatively to 0.7mm (range, 0mm - less than 2.9mm) postoperatively (p<0.05, paired two-tailed t-test). Clinical findings at last follow-up examination included resolved foveal subretinal fluid in 100%(11/11) of eyes, mild mottling of the retinal pigment epithelium in the region of the tumor in 100%(11/11) of eyes, and residual choroidal hemangioma elevation in 55%(6/11) of eyes. No retinal vascular occlusion, nerve fiber bundle defect, or progressive vision loss was detected in any eye, including 3 with peripapillary tumors. No eye developed recurrent tumor growth or recurrent vision loss. Conclusions: Photodynamic therapy with verteporfin appears safe and effective for improving visual acuity and reducing tumor height in eyes with symptomatic choroidal hemangioma. Preliminary results suggest the possibility that peripapillary treatment may not be associated with optic nerve damage. Further studies are needed to identify the most effective PDT laser treatment protocol.

Keywords: photodynamic therapy • tumors