Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma.
OBJECTIVE
To evaluate photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH).


METHODS
Prospective, multicenter, nonrandomized clinical trial.


METHODS
Thirty-one eyes of 31 patients with posterior pole CCH and symptoms caused by exudation into the macular area.


METHODS
Photodynamic therapy was applied by Zeiss laser. Intravenous verteporfin at 6 mg/m(2) body surface was administered before treatment, and light emitted at 689 nm for photosensitization. The treatment spot diameter was calculated on early-phase frames of pretreatment indocyanine green angiography. Fifteen minutes after starting the verteporfin infusion, the laser beam was applied to the retina at radiant exposure 50 J/cm(2) and exposure time 83 seconds. One to 4 treatments were applied at 12-week intervals over 1 year. Standardized evaluation was performed before and at 4-week intervals after each treatment, and at 3, 6, 9, and 12 months. All patients were followed for >or=12 months.


METHODS
The primary outcome measure was the absence of exudative retinal detachment at the 12-month follow-up visit on ophthalmoscopy, fluorescein angiography, and optical coherence tomography. Secondary measures were the visual acuity outcome, with best-corrected visual acuity determined by the Early Treatment for Diabetic Retinopathy Study chart, tumor thickness decrease on B-scan ultrasonography, and adverse events.


RESULTS
Among the total, 82.8% of patients required 1, 13.8% 2, and 3.4% 3 PDTs to eliminate exudative retinal detachment. Visual acuity increased from a mean of 20/60 to 20/35 (P<0.001). Sixty-nine percent of patients demonstrated visual recovery (P<0.001). Cystoid macular edema regressed in all cases and exudative macular detachment disappeared in all but 2 cases. The CCH thickness decreased in all cases from a mean of 3.0 to 1.7 mm, with the most intense effect seen after 4 weeks of treatment (P<0.001). Visual fields showed resolution of central scotomas. There were no severe adverse events.


CONCLUSIONS
Combining PDT with the standard age-related macular degeneration protocol is an effective treatment for CCH in terms of resolution of exudative subretinal fluid and recovery of VA.


BACKGROUND
The authors have no proprietary or commercial interest in any materials discussed in this article.
Boixadera
Anna
A
Department of Ophthalmology, Hospital Vall d'Hebron, Barcelona, Spain. aboixadera@hotmail.com
García-Arumí
José
J
Arumí
José García
JG
Martínez-Castillo
Vicente
V
Encinas
Jose Luis
JL
Elizalde
Javier
J
Blanco-Mateos
Gonzalo
G
Caminal
Jose
J
Capeans
Carmela
C
Armada
Félix
F
Navea
Amaparo
A
Olea
Jose Luis
JL
D000328:Adult; D000368:Aged; D002830:Choroid Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D010778:Photochemotherapy; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D011166:Porphyrins / Q000627:therapeutic use*; D011446:Prospective Studies; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D000077362:Verteporfin; D014792:Visual Acuity
D004396:Coloring Agents; D017319:Photosensitizing Agents; D011166:Porphyrins; D000077362:Verteporfin; D007208:Indocyanine Green