Benefits and complications of photodynamic therapy of papillary capillary hemangiomas.
OBJECTIVE
To evaluate the potential benefit and risks of photodynamic therapy (PDT) in the treatment of papillary capillary hemangioma.


METHODS
Prospective, noncomparative, interventional case series.


METHODS
Five patients with solitary capillary hemangioma on the temporal portion of the optic nerve presenting with exudative decompensation and decrease in visual acuity (VA).


METHODS
All eyes received a standardized PDT treatment with 6 mg/kg body surface area verteporfin and application of 100 J/cm(2) light at 692 nm. One to three PDT courses were performed until resolution of exudation was achieved. A continuous follow-up was provided with documentation 1 week before and at 4 to 6 weeks, 3 months, and 12 months after the last treatment application.


METHODS
Functional parameters included best-refracted VA (Early Treatment Diabetic Retinopathy Study), and central scanning laser ophthalmoscope (SLO) scotometry and peripheral (automated perimetry) visual fields; anatomic parameters were presence of retinal edema or serous detachment (ophthalmoscopy) and tumor size (ultrasonography).


RESULTS
Pretreatment VA levels ranged from 20/40 to 20/800; posttreatment levels ranged from 20/64 to 20/2000. Tumor regression with resolution of macular exudate and serous retinal detachment was obtained in all eyes. A decline in VA of 1, 3, and 10 lines, respectively, was documented in three patients. Complications included transient decompensation of vascular permeability, occlusion of retinal vessels, and ischemia of the optic nerve.


CONCLUSIONS
PDT is successful in reducing tumor size and exudative activity. Vaso-occlusive effects at the level of the retina and optic nerve compromise the functional benefit. Parameters proven safe in choroidal neovascularization may be inappropriate in retinal capillary lesions of the optic nerve.
Schmidt-Erfurth
Ursula M
UM
Department of Ophthalmology, the University Eye Hospital, Ratzeburger Allee 160, 23538 Lübeck, Germany.
Kusserow
Christine
C
Barbazetto
Irene A
IA
Laqua
Horst
H
D000328:Adult; D002199:Capillary Permeability / Q000187:drug effects; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D018324:Hemangioma, Capillary / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D009898:Optic Disk / Q000098:blood supply*; D019574:Optic Nerve Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018917:Optic Neuropathy, Ischemic / Q000139:chemically induced; D010778:Photochemotherapy / Q000009:adverse effects; D017319:Photosensitizing Agents / Q000009:adverse effects / Q000627:therapeutic use*; D011166:Porphyrins / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D015356:Retinal Artery Occlusion / Q000139:chemically induced; D012170:Retinal Vein Occlusion / Q000139:chemically induced; D000077362:Verteporfin; D014792:Visual Acuity; D014794:Visual Fields
D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin