Abstract
Purpose :
To compare the outcomes of transpupillary thermotherapy (TTT) v/s photodynamic therapy (PDT) in patients with circumscribed choroidal hemangioma (CCH).
Methods :
Fifty-four cases were retrospectively evaluated in this study, in which 42 were treated with TTT and 12 cases were treated with PDT.
1: TTT using infrared diode laser (810nm) was adapted on a Haag Strait slit lamp biomicroscope and delivered through a Mainster lens. Themedian spot size of 1.2 mm, power of 250 mW and exposure time of 2.5 minutes was needed in our patients.
Treatment group 2: PDT (half fluence in 10 patients and standard fluence in 2 patients) usingZiess laser emitting a light at 689nm for photosensitisation and intravenously administered Verteporfin (Visudyne; Novartis Ophthalmics AG, Basel, Switzerland) at a dose of 6 mg/m2 body surface. The diameter of the spot size was determined by examining the pre-treatment indocyanine green angiography frames. The median spot size and dosage was 5mm and 5.4 respectively.
Results :
The median age group of the study population was 39 years with a M:F ratio of 3.2. The median tumour dimensions in TTT group were (in mm): thickness (3.3); horizontal diameter (8.2); vertical diameter (7.4) whereas in PDT group were thickness (3.1); horizontal diameter (7.8); vertical diameter (7.5). Foveal involvement was noted in 25% in each group (11/42 v/s 3/12). In group 1, at the final visit, visual acuity improved or maintained in 30 (71.4%) eyes and worsened in 12 (28.6%) eyes. In group 2, 9 (75%) patients showed a maintenance/improvement in visual acuity and 3 (25%) showed worsening by 2 or more lines. Visual acuity of 20/40 or better was observed in 8 (66.7%) of the patients. The final visual acuity was noted be slightly better in group 2, but was not found to be statistically significant (p value 0.09). Tumor dimensions (thickness, horizontal and vertical diameter) did not significantly alter the outcomes (p value 0.57,1, 0.67 respectively).
Conclusions :
The two treatment modalities produce similar visual outcomes, although PDT is preferred in sub-foveal lesions due to its safety profile. Although TTT is a cheaper treatment modality of the two, it needs more treatment sessions compared to PDT (2.8 v/s 1.08).
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.