Photodynamic therapy of symptomatic choroidal nevi

Abstract

Purpose: To evaluate the role of photodynamic therapy (PDT) for patients with symptomatic choroidal nevi involving the fovea or located near the fovea with subretinal fluid extending to the fovea.

Materials and methods: Retrospective review of five patients who underwent PDT for choroidal nevi at two separate centers in Ankara and Barcelona.

Results: The mean initial logMAR visual acuity was 0.5 (range: 0 to 1.5). The mean largest tumor base diameter was 3.2 mm (range: 2.1-4.5 mm) and the mean tumor thickness was 1.1 mm (range: 0.7-1.6 mm). The mean number of PDT sessions was 1.6 (range:1-3). The mean final tumor thickness was 1.0 mm (range: 0-1.6 mm) at a mean follow-up of 19 months (range: 12-32 months). The mean final logMAR visual acuity was 0.4 (range: 0-1.5). Subfoveal fluid disappeared or decreased significantly in 4 of 5 eyes (80%) after PDT.

Conclusions: PDT led to resolution of subretinal fluid with preservation of visual acuity in many symptomatic choroidal nevi in this study. Careful case selection is important as PDT of indeterminate pigmented tumors may delay the diagnosis and treatment of an early choroidal melanoma and thereby increase the risk for metastasis.

Keywords: Choroidal Melanocytic Lesion; Choroidal Melanoma; Choroidal Nevus; Photodynamic Therapy; Transpupillary Thermotherapy.

Figure 1

Patient 4. Right eye. Color fundus photograph (a), mid phase fluorescein angiogram (b) and fundus autofluorescence photograph (c) of a 48-year-old male with a choroidal nevus demonstrating orange pigment on the lesion and subretinal fluid in the fovea. Optical coherence tomography (OCT) at baseline (d) shows the presence of intraretinal fluid and presumed fibrin collection. OCT after third photodynamic therapy (e) shows improvement in central retinal thickness with marked resolution of the intraretinal material and persistence of subretinal fluid at 24 months follow-up

Figure 2

Patient 5. Left eye. Color fundus photograph (a), fluorescein angiogram (b) and ocular ultrasonogram (c) of a 74-year-old male with a peripapillary choroidal nevus with orange pigment over the lesion surface and subretinal fluid under the fovea. Optical coherence tomography (OCT) at baseline (d) shows the presence of subretinal fluid. OCT 3 months after a single session of photodynamic therapy (e) shows improvement in central retinal thickness and almost complete resolution of neurosensory retinal detachment