Photodynamic therapy for retinal capillary hemangioma

Abstract

Purpose: To describe the results of photodynamic therapy (PDT) for juxtapapillary and peripheral retinal capillary hemangioma (RCH).

Patients and methods: Interventional case series of four eyes (four patients) with juxtapapillary RCH and one eye (one patient) with peripheral RCH. Two eyes with juxtapapillary RCH had received two sessions of full-fluence, double-duration PDT; whereas other two eyes had received single session of half-fluence, single-duration PDT. The peripheral RCH was treated with a single session of full-fluence, single-duration PDT.

Results: Two patients had von Hippel-Lindau disease. Follow-up duration ranged from 4 months to 1 year. Pre-PDT visual acuity (VA) ranged from 20/200 to HM (juxtapapillary RCH) and 20/100 (peripheral RCH). Among the eyes with juxtapapillary RCH, tumor regression with partial resolution of macular edema was noted in two eyes (one eye each with half-fluence and full-fluence PDT), whereas two eyes had no change in tumor size with persistent macular edema. VA remained stable in three eyes and declined in one eye. In an eye with peripheral RCH, regression of tumor and macular edema with VA improvement was noted. Post-PDT complications included epiretinal membrane (one eye) and transient exudative retinal detachment (one eye).

Conclusion: PDT can be effective in reducing macular edema associated with RCH but this does not always correspond with an improvement in VA especially for juxtapapillary tumors.

Figure 1

Color fundus photographs (CF) and spectral domain optical coherence tomography (SDOCT) foveal B scans of the right eye of a 32-year-old male (patient 2; a–d) and of a 52-year-old female patient (patient 4). (a) CF photograph of the posterior pole shows a juxtapapillary capillary hemangioma (before PDT) with associated exudative RD. (b) CF photograph shows no change in the capillary hemangioma (21 months after PDT). (c) SDOCT foveal B scan shows macular RD (before PDT). (d) SDOCT foveal B scan shows no significant change (21 months after PDT). (e) CF photograph of the posterior pole shows a juxtapapillary capillary hemangioma overlying the optic nerve (before PDT). (f) CF photograph of the posterior pole shows significant reduction and fibrosis of the capillary hemangioma (26 months after PDT). (g) SDOCT foveal B scan shows macular RD (before PDT). (h) SDOCT foveal B scan shows partial resolution of macular edema with an epiretinal membrane (26 months after PDT).

Figure 2

Color fundus (CF) photographs and spectral domain optical coherence tomography (SDOCT) foveal B scans of the right eye of a 32-year-old female (patient 5) (a–e). (a) CF photograph of the retinal periphery shows a RCH (before PDT). (b) CF photograph of the retinal periphery shows an area of exudative RD and an area of subretinal hemorrhage (1 week after PDT). (c) CF photograph of the retinal periphery shows a regressed RCH (9 months after PDT). (d) SDOCT foveal B scan suggestive of a serous macular detachment (1 week after PDT). (e) SDOCT foveal B scan shows resolved serous macular detachment (2 weeks after PDT). (f) CF photograph of the macula shows regressed exudates with RPE alteration in the fovea. (g) CF photograph of the retinal periphery shows a regressed RCH (9 months after PDT).