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Prospective Clinical Trial Evaluating the Efficacy of Photodynamic Therapy for Symptomatic Circumscribed Choroidal Hemangioma

2008; Elsevier BV; Volume: 116; Issue: 1 Linguagem: Inglês

10.1016/j.ophtha.2008.08.029

1549-4713

Anna Boixadera, José Garcia-Arumı́, Vicente Martínez-Castillo, José Luis Encinas, Javier Elizalde, G Blanco-Mateos, J. Maria Caminal Mitjana, Carmela Capeáns, Félix Armadá, Amparo Návea, J.L. Olea,

Ocular Diseases and Behçet’s Syndrome

PurposeTo evaluate photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH).DesignProspective, multicenter, nonrandomized clinical trial.ParticipantsThirty-one eyes of 31 patients with posterior pole CCH and symptoms caused by exudation into the macular area.InterventionPhotodynamic therapy was applied by Zeiss laser. Intravenous verteporfin at 6 mg/m2 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/cm2 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 ≥12 months.Main Outcome MeasuresThe 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.ResultsAmong 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.ConclusionsCombining 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.Financial Disclosure(s)The authors have no proprietary or commercial interest in any materials discussed in this article. To evaluate photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH). Prospective, multicenter, nonrandomized clinical trial. Thirty-one eyes of 31 patients with posterior pole CCH and symptoms caused by exudation into the macular area. Photodynamic therapy was applied by Zeiss laser. Intravenous verteporfin at 6 mg/m2 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/cm2 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 ≥12 months. 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. 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. 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.