Photodynamic therapy for symptomatic choroidal hemangioma: visual and anatomic results

Abstract

Objective: To document the anatomic and functional outcome of photodynamic therapy (PDT) in symptomatic choroidal hemangioma

Design: Prospective, noncomparative, interventional case series.

Participants: Fifteen patients with circumscribed choroidal hemangioma of the posterior pole presenting with progressive vision loss caused by exudation into the macular area.

Intervention: PDT using 6 mg/m(2) body surface area verteporfin and a light dose of 100 J/cm(2) at 692 nm was performed. One to four treatments with a single laser spot were applied in 6-week intervals. A standardized evaluation was provided before and at 6-week intervals after each treatment, at 3, 6, and 12 months, and a mean follow-up 19 months after the last application.

Main outcome measures: Functional tests included best-refracted visual acuity (Early Treatment of Diabetic Retinopathy Study criteria) and scanning laser scotometry. Anatomic results were documented by ophthalmoscopy, fluorescein/indocyanine green angiography, and ultrasonography.

Results: A complete regression of the vascular mass was achieved in all eyes after the last course of one to four consecutive treatments. Tumors (mean height, 3.8 mm) responded with a reproducible decrease in size to each treatment, with the most intensive effect seen after the first application. Progressive occlusion of the angiomatous net without recanalization was documented angiographically. Two patients had stable vision with resolution of metamorphopsia; 13 patients demonstrated visual recovery. An overall visual acuity (VA) improvement of an average of 3 lines was documented, with a mean VA level of 20/125 before treatment and 20/80 after therapy. Visual fields showed withdrawal of central scotomas from the macula. No recurrence was seen during a follow-up for up to 50 months.

Conclusions: PDT using verteporfin offers a safe and effective option to treat choroidal hemangiomas. Complete anatomic regression with persistent absence of leakage is associated with substantial improvements in vision.