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Lupidi M, Centini C, Castellucci G, Nicolai M, Lassandro N, Cagini C, Rizzo C, Chhablani J, Mariotti C. New insights on circumscribed choroidal hemangioma: "bench to bedside". Graefes Arch Clin Exp Ophthalmol 2024; 262:1093-1110. [PMID: 37505277 PMCID: PMC10995022 DOI: 10.1007/s00417-023-06179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/12/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
Circumscribed choroidal hemangioma is a rare vascular hamartoma of the choroid, presenting as a red-orange mass at the posterior pole on fundoscopic examination. Despite its benign origin, associated complications such as subretinal fluid, serous retinal detachment, retinoschisis and neovascular glaucoma may lead to serious visual impairment in more than half patients. Because of its similarity to amelanotic choroidal melanoma and choroidal metastasis, differential diagnosis is still challenging for specialists. Multimodal imaging such as ultrasonography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography guides the clinician to the correct diagnosis and the proper follow-up. Treatment is indicated in symptomatic cases in order to resolve exudation and improve visual acuity. Treatment options include photocoagulation, transpupillary thermotherapy, radiation therapy, photodynamic therapy and anti-vascular endothelial growth factor therapy. Currently, photodynamic therapy is the treatment of choice due to its effectiveness and safety. The purpose of this review is to describe the latest knowledge in the etiopathogenesis of the circumscribed choroidal hemangioma, the most recent multimodal imaging findings, and the available treatment options.
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Affiliation(s)
- Marco Lupidi
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy.
- Fondazione Per La Macula Onlus, Dipartimento Di Neuroscienze, Riabilitazione, OftalmologiaGenetica e Scienze Materno-Infantili (DINOGMI), University Eye Clinic, Genoa, Italy.
| | - Chiara Centini
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Greta Castellucci
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Michele Nicolai
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Nicola Lassandro
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Cagini
- Department of Medicine and Surgery, University of Perugia, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Clara Rizzo
- Ophthalmic Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Jay Chhablani
- Department of Ophthalmology, UPMC Eye Center, University of Pittsburgh, Pittsburgh, USA
| | - Cesare Mariotti
- Eye Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
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Jorge R, Chaves L, Cunha ADS, Correa ZM. ALTERNATIVE MANAGEMENT OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA USING INTRAVITREAL METOPROLOL. Retin Cases Brief Rep 2022; 16:106-110. [PMID: 31517744 DOI: 10.1097/icb.0000000000000917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE To describe a patient with visually symptomatic circumscribed choroidal hemangioma (CCH) treated successfully with intravitreal beta-blocker. METHODS This is an interventional single case report of a 63 year-old man with a juxtafoveal CCH and extensive subretinal fluid (SRF) unsuccessfully treated with intravitreal anti-VEGF. Off-label intravitreal use of metoprolol (50μg/0.05 ml) was then performed. Main outcome measures were resolution or decreased subretinal fluid on OCT, visual stability or improvement, lack of retinal/ocular toxicity. RESULTS Following 2 intravitreal injections of metoprolol (1 month apart), significant response was observed with decrease of SRF and visual improvement to 20/400 during a 9-week follow-up after the injections. CONCLUSION These preliminary findings suggest that intravitreal metoprolol can be a safe alternative treatment for patients with CCH. This off-label therapy could represent another option for patients with this condition.
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Affiliation(s)
- Rodrigo Jorge
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Leandro Chaves
- Department of Ophthalmology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Armando da Silva Cunha
- Faculty of Pharmacy, Minas Gerais Federal University, Belo Horizonte, Minas Gerais, Brazil ; and
| | - Zelia M Correa
- Departments of Ophthalmology and Oncology, Wilmer Eye Institute, Sidney Kimmel Comprehensive Cancer Institute, John Hopkins Medicine, Baltimore, Maryland
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Lai K, Gong Y, Xu F, Li L, Huang C, Zhou L, Zhong X, Yang H, Lu L, Jin C. Effectiveness and Safety of Intravitreal Injection of Conbercept as an Initial Treatment for Exudative Circumscribed Choroidal Hemangioma. Ophthalmologica 2020; 243:436-443. [PMID: 31905362 DOI: 10.1159/000505753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the effectiveness and safety of intravitreal injection of conbercept (IVC) as the initial treatment for exudative circumscribed choroidal hemangioma (CCH). METHODS Forty-two eyes of 42 patients received 3 monthly IVC (0.5 mg/0.05 mL) as the initial treatment. Three months later, the patients were assessed for further treatment including observation, reinjection of conbercept, laser photocoagulation (if the lesion was 3,000 μm away from the macular fovea), or photodynamic therapy (PDT; if the lesion was under the macular fovea). Anatomical and functional responses including best corrected visual acuity (BCVA), central foveal thickness (CFT), and tumor size were analyzed. RESULTS Twenty-three patients (54.76%) were sensitive to the monotherapy of IVC. Fourteen patients (33.33%) were insensitive to IVC and underwent rescue laser photocoagulation, and 5 patients (11.90%) underwent rescue PDT due to insensitivity to IVC treatment at 3 months. For subgroup analysis, although no statistical difference was found for BCVA at any follow-up time point compared to baseline, an increasing tendency of BCVA was found in the IVC group (p> 0.05). The mean CFT decreased significantly from 427.13 ± 214.74 μm at baseline to 259.83 ± 61.68 μm at 6 months in the IVC group (p< 0.05). No influence on tumor size was found in the IVC group. CONCLUSION IVC as the initial treatment might be an option for exudative CCH.
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Affiliation(s)
- Kunbei Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yajun Gong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Longhui Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chuangxin Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lijun Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaojing Zhong
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Huasheng Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China,
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O'Bryhim BE, Li AS, Bayliss SJ, Tychsen L, Lueder GT, Rajagopal R. Successful treatment of an exudative choroidal hemangioma with oral propranolol in a 10-year-old boy. J AAPOS 2019; 23:236-238. [PMID: 30959167 PMCID: PMC6778008 DOI: 10.1016/j.jaapos.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/22/2019] [Accepted: 02/03/2019] [Indexed: 10/27/2022]
Abstract
A 10-year-old boy was referred for a circumscribed choroidal hemangioma with underlying exudative detachment of the left eye. To avoid general anesthetics required for laser-based therapy in a child, we began a trial of oral propranolol. The patient's exudative detachment resolved, with resulting improvement in visual acuity, and remained quiescent for 3 years.
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Affiliation(s)
- Bliss E O'Bryhim
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Albert S Li
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Susan J Bayliss
- Department of Dermatology, St. Louis Children's Hospital, St. Louis, Missouri
| | - Lawrence Tychsen
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Gregg T Lueder
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri; Department of Pediatrics, St. Louis Children's Hospital, St. Louis, Missouri
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
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Lee J, Kwon HJ, Kim M, Lee CS, Lee SC. Treatment response to intravitreal bevacizumab in small pigmented choroidal lesions with subretinal fluid. BMC Ophthalmol 2019; 19:103. [PMID: 31053116 PMCID: PMC6499992 DOI: 10.1186/s12886-019-1108-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 04/22/2019] [Indexed: 01/23/2023] Open
Abstract
Background To describe the effects of intravitreal bevacizumab injection (IVB) and/or transpupillary thermotherapy (TTT) in the treatment of small pigmented choroidal lesions with subfoveal fluid (SFF), and to investigate prognostic value of the therapeutic response in future tumor growth. Methods Retrospective chart review of 19 patients, who were diagnosed with choroidal neovascularization (CNV)-free small pigmented choroidal lesions and treated with IVB and/or TTT, was performed. Results Complete resolution of SFF was achieved in two eyes (2/14; 14.3%) after IVB, and in three eyes (3/4; 75%) after TTT. Best corrected visual acuity was improved in two eyes (2/9; 22%) after IVB, and in three eyes (3/4; 75%) after TTT. Among five patients who underwent TTT after IVB, four patients (4/5; 80%) demonstrated additional advantage. All IVBs could not reduce tumor sizes. Rather, tumor growth was detected in seven out of 14 eyes (7/14; 50%) that underwent IVB. None of the patients who underwent TTT showed tumor growth. The lack of treatment response to IVB was suggestive of malignancy, as most small pigmented lesions that had no response to IVB showed tumor growth (86%, p = 0.010). Conclusion IVB was not effective in reducing tumor size and subfoveal fluid in small pigmented choroidal lesions. Therapeutic response to IVB can be used as an indicator between melanoma and nevus in small pigmented choroidal lesion.
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Affiliation(s)
- Junwon Lee
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hee Jung Kwon
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Lee J, Lee CS, Kim M, Lee SC. Retinal fluid changes and therapeutic effects in symptomatic circumscribed choroidal hemangioma patients: a long-term follow up study. BMC Ophthalmol 2018; 18:321. [PMID: 30545324 PMCID: PMC6293569 DOI: 10.1186/s12886-018-0993-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 12/04/2018] [Indexed: 12/20/2022] Open
Abstract
Background Changes in retinal fluid patterns associated with circumscribed choroidal hemangioma (CCH) have not been investigated yet. A long-term follow-up study was performed to evaluate the changes of retinal fluid patterns and treatment responses. Methods We retrospectively reviewed medical records of all CCH patients diagnosed between November 2005 and March 2017. Enrolled patients had visual symptoms, were treatment-naïve, and had been followed-up for more than 2 years. Best corrected visual acuities (BCVA) and the presence, severity, and pattern change of the subretinal fluid (SRF) and intraretinal fluid (IRF) in the macula on optical coherence tomography (OCT) were analyzed at initial presentation and follow-up visits. Results Twenty-six patients were enrolled. All patients received one or more of the following treatments: PDT, TTT, and intravitreal bevacizumab (Avastin) injection (IVB). Primary therapy consisted of PDT in 9 patients (34.6%), TTT in 7 patients (26.9%) and IVB in 10 patients (38.5%). At initial presentation, the SRF-only pattern was mostly observed. Despite treatment, IRF occurred over time; eventually, advanced cystoid macular oedema (CME) developed. In terms of retinal fluid reduction, PDT was most efficacious (9/9, 100%), and TTT and IVB showed moderate efficacy (TTT: 4/7, 57.1%; IVB: 5/10, 50%) as a primary therapy. After advanced CME developed, IVB and TTT showed no or minimal effect (TTT: 0/1, 0%; IVB: 0/19, 0%), and PDT was the only effective therapy (6/10, 60%). Conclusion The pattern of retinal fluid accompanied by CCH evolved from an SRF-only pattern initially to an advanced CME pattern. The effectiveness of treatments decreased over time, and advanced CME generally showed resistance to treatments. PDT would be the most recommended treatment.
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Affiliation(s)
- Junwon Lee
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kim
- Department of Ophthalmology, Institute of Human Barrier Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung Chul Lee
- Department of Ophthalmology, Eye and ENT Hospital, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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Ho YF, Chao A, Chen KJ, Chao AN, Wang NK, Liu L, Chen YP, Hwang YS, Wu WC, Lai CC, Chen TL. Clinical outcomes and predictors of response to photodynamic therapy in symptomatic circumscribed choroidal hemangioma: A retrospective case series. PLoS One 2018; 13:e0197088. [PMID: 29851977 PMCID: PMC5979035 DOI: 10.1371/journal.pone.0197088] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background To investigate the treatment outcomes and predictors of response to photodynamic therapy (PDT) in patients with symptomatic circumscribed hemangioma (CCH). Methods This retrospective case series examined 20 patients with symptomatic CCH (10 submacular CCHs and10 juxtapapillary CCHs) who underwent standard PDT (wavelength: 662 nm; light dose: 50J/cm2; exposure time: 83 sec) with verteporfin (6mg/m2), either as monotherapy (n = 9) or in association with other treatments (n = 11), of which 7 received intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF). A post-PDT improvement of at least two lines in best-corrected visual acuity (BCVA) was the primary outcome measure. Predictors of response were investigated with binary logistic regression analysis. Results Seventeen (85%) patients received one PDT session, and three patients (15%) underwent PDT at least twice. Ten patients (50%) achieved the primary outcome of a post-PDT BCVA improvement of at least two lines. Macular atrophy and recalcitrant cystoid macular edema in 2 patients. Binary logistic regression analysis revealed that younger age (< 50 years) (P = 0.033), pre-PDT BCVA of ≧20/200 (P = 0.013), exudative retinal detachment resolved within one month after PDT (P = 0.007), and a thinner post-PDT tumor thickness (P = 0.015) were associated with the achievement of a post-PDT BCVA improvement. Additional treatments to PDT including IVI anti-VEGF did not appear to improve visual and anatomical outcomes. Conclusions Symptomatic CCHs respond generally well to PDT. Patients with younger age (< 50 years), pretreatment BCVA≥ 20/200, and thinner foveal edema are most likely to benefit from this approach.
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Affiliation(s)
- Yeen-Fey Ho
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Yeezen General Hospital, Taoyuan, Taiwan
| | - Anne Chao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
| | - Nan-Kai Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Po Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tun-Lu Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Kwon JM, Lee SM, Kwon HJ, Park SW, Lee JE, Byon IS. Treatment Outcome of Serous Macular Detachment in Circumscribed Choroidal Hemangioma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.3.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jeong Min Kwon
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Seung Min Lee
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Han Jo Kwon
- Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
| | - Sung Who Park
- Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ji Eun Lee
- Medical Research Institute, Department of Ophthalmology, Pusan National University Hospital, Busan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
| | - Ik Soo Byon
- Research Institute for Convergence of Biomedical Science and Technology, Department of Ophthalmology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Ophthalmology, Pusan National University School of Medicine, Yangsan, Korea
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Subirà O, Brosa H, Lorenzo-Parra D, Arias-Barquet L, Català-Mora J, Cobos E, Garcia-Bru P, Rubio-Caso MJ, Caminal-Mitjana JM. Choroidal haemangioma and photodynamic therapy. Anatomical and functional response of patients with choroidal hemangioma treated with photodynamic therapy. ACTA ACUST UNITED AC 2016; 92:257-264. [PMID: 28017484 DOI: 10.1016/j.oftal.2016.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/03/2016] [Accepted: 11/20/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the effectiveness and limitations of photodynamic therapy (PDT) as treatment of choice in patients with symptomatic circumscribed choroidal haemangioma. METHODS A retrospective study was conducted on 16 patients (13 men and 3 women, with mean age of 54.88 years) with circumscribed choroidal haemangioma, who attended our centre and were treated with PDT in the last 7 years. RESULTS All patients had circumscribed choroidal haemangioma, which caused a decrease in visual acuity (VA) secondary to the presence of intraretinal microcystic oedema or neurosensory detachment. The mean initial VA was 0.23, and the final mean VA after performing PDT was 0.38 (all the VA were measured in decimal scale). It should be noted that patients needed a mean of 1.69 PDT sessions. Three of the patients needed rescue treatment with trans-pupillary thermotherapy, intravitreal injection of anti-vascular endothelial growth factor (ranibizumab, aflibercept) or a dexamethasone intravitreal implant (Ozurdex®). The indication for a change of treatment was the persistence of intraretinal microcystic oedema and/or neurosensory detachment (or incomplete resolution) after 3 PDT sessions. As overall results, 62.5% of patients evolved into anatomical and functional (increase in AV or stability) resolution. CONCLUSIONS PDT is a straight forward and fast procedure, with a good anatomical and functional response, causing minimal damage to adjacent vessels.
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Affiliation(s)
- O Subirà
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España.
| | - H Brosa
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - D Lorenzo-Parra
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - L Arias-Barquet
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - J Català-Mora
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - E Cobos
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - P Garcia-Bru
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - M J Rubio-Caso
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
| | - J M Caminal-Mitjana
- Departamento de Oftalmología, Hospital Universitario de Bellvitge. , L'Hospitalet de Llobregat, Barcelona, España
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Abstract
PURPOSE To report a case of visual loss associated with traumatic choroidal rupture after blunt ocular trauma that was successfully treated with an early intravitreal bevacizumab injection despite the absence of choroidal neovascularization (CNV). CASE REPORT A 14-year-old boy presented with visual disturbance in his left eye after sustaining an ocular contusion 4 weeks earlier. The best-corrected visual acuity (BCVA) in the left eye was 20/50. Funduscopic examination revealed macular choroidal rupture accompanied by subretinal hemorrhage. Optical coherence tomography (OCT) showed accumulation of subretinal fluid around a disrupted retinal pigment epithelium/Bruch membrane complex extending into the juxtafoveolar area, but there was no active leakage suggestive of CNV on fluorescein angiography. Intravitreal bevacizumab (1.25 mg) injection was performed to treat persistent serous retinal detachment at macula causing visual loss. There was a reduction of subretinal fluid and concomitant improvement of BCVA to 20/30 within 1 week after intravitreal bevacizumab injection. The BCVA recovered to 20/25 in the left eye after 4 weeks, and only a minimal amount of residual fluid remained according to OCT. Complete resolution of subretinal fluid was observed by OCT at the 6-week follow-up examination, and BCVA improved to 20/20. Good visual acuity (20/20) and stable macula were maintained in the left eye at 1 year of follow-up without recurrence of subretinal fluid accumulation or hemorrhage and CNV. There were no ocular or systemic complications associated with intravitreal bevacizumab injection. CONCLUSIONS Early intravitreal bevacizumab injection could be an effective treatment option for patients with vision loss associated with traumatic choroidal rupture and subretinal fluid within the posterior pole before development of CNV.
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11
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Heimann H, Jmor F, Damato B. Imaging of retinal and choroidal vascular tumours. Eye (Lond) 2012. [PMID: 23196648 DOI: 10.1038/eye.2012.251] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The most common intraocular vascular tumours are choroidal haemangiomas, vasoproliferative tumours, and retinal haemangioblastomas. Rarer conditions include cavernous retinal angioma and arteriovenous malformations. Options for ablating the tumour include photodynamic therapy, argon laser photocoagulation, trans-scleral diathermy, cryotherapy, anti-angiogenic agents, plaque radiotherapy, and proton beam radiotherapy. Secondary effects are common and include retinal exudates, macular oedema, epiretinal membranes, retinal fibrosis, as well as serous and tractional retinal detachment, which are treated using standard methods (ie, intravitreal anti-angiogenic agents or steroids as well as vitreoretinal procedures, such as epiretinal membrane peeling and release of retinal traction). The detection, diagnosis, and monitoring of vascular tumours and their complications have improved considerably thanks to advances in imaging. These include spectral domain and enhanced depth imaging optical coherence tomography (SD-OCT and EDI-OCT, respectively), wide-angle photography and angiography as well as wide-angle fundus autofluorescence. Such novel imaging has provided new diagnostic clues and has profoundly influenced therapeutic strategies so that vascular tumours and secondary effects are now treated concurrently instead of sequentially, enhancing any opportunities for conserving vision and the eye. In this review, we describe how SD-OCT, EDI-OCT, autofluorescence, wide-angle photography and wide-angle angiography have facilitated the evaluation of eyes with the more common vascular tumours, that is, choroidal haemangioma, retinal vasoproliferative tumours, and retinal haemangioblastoma.
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Affiliation(s)
- H Heimann
- Ocular Oncology Unit, Royal Liverpool University Hospital, Liverpool, UK.
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