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A. Kahana, B. Blodi, M. Ip, M. Wolf; Photodynamic Therapy for Treatment of a Choroidal Hemangioma: Three Case Reports . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4859.
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Purpose: Circumscribed choroidal hemangioma (CCH) is a rare benign vascular hamartoma that can cause visual loss by exudative retinal detachment. Attempts to treat CCH have used a variety of techniques to reduce tumor size and subretinal fluid in the fovea. Strategies have included photocoagulation, radioactive plaques, external beam radiation, and thermotherapy. Treatment has often been complicated by recurrence of sub-retinal fluid and/or macular damage from treatment. The successful use of photodynamic therapy (PDT) with verteporfin has recently been described for treating symptomatic CCH. However, the parameters of treatment have differed. We describe three cases of CCH treated with PDT using different treatment parameters. Methods: Retrospective chart review of three patients with CCH who were treated with PDT at two urban eye clinics. Results: Two patients with symptomatic CCH were treated with PDT using the standard protocol described for treatment of age-related macular degeneration. One, in which symptoms and underlying subretinal fluid were long-standing, showed improved anatomy but no significant change in visual acuity. The second patient had a more acute presentation, and following treatment with PDT, symptoms were significantly improved both objectively and subjectively. A third patient with a newly symptomatic CCH was treated with PDT using a modified protocol: rapid infusion of verteporfin, and increased exposure time to activating light beam (160 seconds instead of 80). Following initial improvement in anatomy and symptoms, visual acuity deteriorated and clinical exam revealed significant RPE atrophy likely related to post-treatment effects. Conclusions: Photodynamic therapy may be an effective treatment for symptomatic circumscribed choroidal hemangiomas. Careful selection of patients likely to benefit from treatment is an important consideration. Care should be used in choosing the appropriate treatment protocol to achieve maximum visual improvement with minimal symptomatic recurrences and complications of treatment. With increasing collective experience, treatment parameters for PDT in treating CCH will become more refined and, hopefully, more reproducibly successful.
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