Treatment outcomes of PDT for circumscribed choroidal haemangioma

Abstract

Purpose : Choroidal haemangioma is a benign vascular tumour which presents as diffuse-type disease (often associated with Sturge-Weber syndrome) or a circumscribed choroidal haemangioma (CCH). CCH often arise near the posterior pole and can cause poor vision due to chronic macular oedema and serous retinal detachment. Photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis) offers selective irradiation of the CCH whilst sparing the overlying retina. We hypothesise that PDT is a safe and effective treatment for CCH.

Methods : Patients received intravenous infusion (IVI) of verteporfin (6mg/m²) followed, 15 minutes later, by administration of 690nm diode laser (600mW/cm² irradiance, 83s duration, 50mJ/cm² fluence) to the tumour. Best corrected visual acuity (BCVA, ETDRS letter score), optical coherence tomography (OCT) measurements (central retinal thickness [CRT], centre retinal lesion thickness [CRLT] and whether the retina was ‘dry’) and a subjective assessment of visual function were recorded pre-treatment, at 3-month, and each subsequent annual, follow-up.

Results : 15 patients with CCH received PDT between January 2007 and June 2015. The mean age was 56 years (range 32-82) with a male preponderance (n=10). Mean follow-up was 21 months (range 3-40). Two patients received a single PDT retreatment during follow-up (at 17 months, and 5 years). One patient required two retreatments (at 26 & 55 months). Mean(±SD) BCVA was 58(±19) letters pre-treatment, with mean improvement from baseline of 7 letters at 3-month, 10 at 1-year, 10 at 2-year, and 2 at 3-year follow-up. Mean(±SD) CRT was 327(±89)µm pre-treatment, 244(±52)µm at 3-months, 244(±110)µm at 1-year, 259(±36)µm at 2-years and 290(±59)µm at 3-years. CRLT was 411(±154)µm pre-treatment and was reduced throughout follow-up: 3 months, 301(±56)µm; 1-year, 362(±114)µm; 2-years, 378(±43)µm; 3-years, 361(±35)µm. OCT images showed the retina to be ‘dry’ in 42% of patients (n=5) at 3-months, 70% (n=7) at 1-year, 67% (n=4) at 2-years and in all four patients achieving 3-year follow-up. Subjective visual improvement was noted in 67% (n=8) at 3-months, 90% (n=9) at 1-year, 67% (n=4) at 2-years and 75% (n=3) at 3-years. No side-effects of treatment were noted during the follow-up period.

Conclusions : PDT with verteporforin is a safe and effective treatment for CCH. Treatment with PDT results in both structural (OCT measurements) and functional (subjective visual function, BCVA) improvements.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.