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Wang L, Tang T, Wang J, Lin T, Li Y, Song X. Could a low-dose definitive radiation therapy be the optimal treatment for choroidal hemangioma? Radiother Oncol 2024; 196:110282. [PMID: 38641260 DOI: 10.1016/j.radonc.2024.110282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
PURPOSE To determine the efficacy of low-dose intensity-modulated radiation therapy (IMRT)/volumetric intensity-modulated arc therapy (VMAT) in the treatment of symptomatic choroidal hemangioma (CH). MATERIALS AND METHODS Fifty-three consecutive patients with CH were retrospectively reviewed. All the patients underwent IMRT/VMAT as a unique treatment. Resolution of subretinal fluid (SRF), improvement of best-corrected visual acuity (BCVA), and reduction in tumor thickness were compared before and after radiotherapy. RESULTS After definitive radiotherapy, 100 % of SRF and 76.7 % of exudative retinal detachment were resolved. 56.6 % of BCVA improvement in more than two lines was observed. The mean best-corrected visual acuity was 20/280 (range, 20/1200-20/40) at diagnosis and 20/100 (range, 20/1200-20/20) after treatment. The mean tumor thickness decreased significantly from 3.8 mm initially to 1.2 mm after treatment (p < 0.01). 66.0 % of patients were delivered with 21.6 Gy (range, 21.6-42 Gy), 84.9 % of fractional dose was 1.8 Gy (range, 1.8-2 Gy). No radiation-induced keratitis, retinopathy, or optic neuropathy were observed. Initial vision (p = 0.042), duration time of vision (p = 0.004), and tumor thickness (p = 0.049) were prognostic factors for vision recovery. CONCLUSION Low-dose IMRT/VMAT could effectively induce involution of the CH, with reduction of subretinal fluid and relief of damage to the neurosensory retina, which is an effective treatment mode for CH.
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Affiliation(s)
- Li Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China
| | - Tianci Tang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China
| | - Jie Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China
| | - Tong Lin
- Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China
| | - Yi Li
- Department of Oncology, 920th Hospital of Joint Logistics Support Force, 212 Daguan Road, Kunming 650031, China.
| | - Xinmao Song
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China.
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Bajpai V, Raval V, Reddy P VA, Kaliki S. Ruthenium-106 ( 106Ru) plaque brachytherapy for treatment of circumscribed choroidal hemangioma. Eur J Ophthalmol 2024:11206721241257974. [PMID: 38794917 DOI: 10.1177/11206721241257974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
PURPOSE To describe the clinical and imaging features of circumscribed choroidal hemangiomas (CCH) and their treatment outcomes with Ruthenium-106 (106Ru) plaque brachytherapy. METHODS Retrospective study of 24 patients (24 eyes) diagnosed with CCH and treated with 106Ru plaque between 2017 and 2022. Analysis included pre- and post-treatment clinical and imaging features such as tumor regression, reduction in height, subretinal fluid (SRF) resolution, and change in best-corrected visual acuity (BCVA). RESULTS The mean age at presentation was 36 years (range, 16-57). The most common tumor location was the temporal quadrant (n = 19) with macular involvement (n = 13). Associated features were macular SRF (n = 22) and inferior exudative retinal detachment (n = 10). Nineteen of the 24 patients underwent primary treatment, whereas 5 patients underwent plaque as a salvage treatment. The mean tumor apex dose was 40 Gy. At a median follow-up of 7.5 months (range 3-65 months), 18 eyes showed complete regression, whereas 6 eyes showed partial regression. The mean height decreased from 4.8 (SD 1.28) mm at presentation to 2.5 (SD 1.63) mm. Median BCVA improved from logMAR 1.2 (IQR 0.4-2) at baseline to logMAR 1.05 (IQR 0.1-1.95) (p = 0.4). Complete resolution of the macula and tumor SRF was observed in 15 (68%) and 13 (57%) eyes, respectively. The radiation-related complications observed were radiation maculopathy (4 eyes), retinopathy (1 eye), and vitreous hemorrhage (1 eye). CONCLUSION Ruthenium-106 plaque brachytherapy is effective for CCH (> 3 mm height) as a primary and salvage treatment for tumors unresponsive to other modalities.
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Affiliation(s)
- Vidhi Bajpai
- Anand Bajaj Retina Institute, L.V. Prasad Eye Institute, Hyderabad, India
| | - Vishal Raval
- Anand Bajaj Retina Institute, L.V. Prasad Eye Institute, Hyderabad, India
- The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India
| | - Vijay Anand Reddy P
- The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India
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β-Adrenoreceptors as Therapeutic Targets for Ocular Tumors and Other Eye Diseases-Historical Aspects and Nowadays Understanding. Int J Mol Sci 2023; 24:ijms24054698. [PMID: 36902129 PMCID: PMC10003534 DOI: 10.3390/ijms24054698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
β-adrenoreceptors (ARs) are members of the superfamily of G-protein-coupled receptors (GPCRs), and are activated by catecholamines, such as epinephrine and norepinephrine. Three subtypes of β-ARs (β1, β2, and β3) have been identified with different distributions among ocular tissues. Importantly, β-ARs are an established target in the treatment of glaucoma. Moreover, β-adrenergic signaling has been associated with the development and progression of various tumor types. Hence, β-ARs are a potential therapeutic target for ocular neoplasms, such as ocular hemangioma and uveal melanoma. This review aims to discuss the expression and function of individual β-AR subtypes in ocular structures, as well as their role in the treatment of ocular diseases, including ocular tumors.
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Kumar A, Shankar S, Singh A, Mishra S, Kumar P, Arora A. Photodynamic therapy in the treatment of circumscribed choroidal hemangioma: Current perspectives. Photodiagnosis Photodyn Ther 2022; 39:103000. [DOI: 10.1016/j.pdpdt.2022.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
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Starace V, Cicinelli MV, Cavalleri M, Di Muzio N, Marchese A, Battista M, Bandello F, Miserocchi E, Modorati G. Ocular leukemic mass-like relapse treated with CyberKnife stereotactic radiosurgery. Acta Ophthalmol 2022; 100:e1036-e1038. [PMID: 34327856 DOI: 10.1111/aos.14986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/27/2021] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Vincenzo Starace
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Maria Vittoria Cicinelli
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Michele Cavalleri
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Nadia Di Muzio
- Department of Radiotherapy IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Alessandro Marchese
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Marco Battista
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Francesco Bandello
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
- School of Medicine Vita‐Salute San Raffaele University Milan Italy
| | - Elisabetta Miserocchi
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
| | - Giulio Modorati
- Department of Ophthalmology IRCCS Ospedale San Raffaele University Vita‐Salute San Raffaele Milan Italy
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COMPARATIVE EFFECTIVENESS OF PROTON BEAM VERSUS PHOTODYNAMIC THERAPY TO SPARE THE VISION IN CIRCUMSCRIBED CHOROIDAL HEMANGIOMA. Retina 2021; 41:277-286. [PMID: 32404844 DOI: 10.1097/iae.0000000000002843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to compare the functional and anatomical effectiveness of photodynamic therapy (PDT) versus proton beam therapy (PBT) in a real-life setting for the treatment of circumscribed choroidal hemangioma. METHODS A total of 191 patients with a diagnosis of circumscribed choroidal hemangioma and treated by PBT or PDT were included for analyses. RESULTS The 119 patients (62.3%) treated by PDT were compared with the 72 patients treated by PBT. The final best-corrected visual acuity did not differ significantly between the two groups (P = 0.932) and final thickness was lower in the PBT compared with the PDT group (P = 0.001). None of the patients treated by PBT needed second-line therapy. In comparison, 53 patients (44.5%) initially treated by PDT required at least one other therapy and were associated with worse final best-corrected visual acuity (P = 0.037). In multivariate analysis, only an initial thickness greater than 3 mm remained significant (P = 0.01) to predict PDT failure with an estimated odds ratio of 2.72, 95% confidence interval (1.25-5.89). CONCLUSION Photodynamic therapy and PBT provide similar anatomical and functional outcomes for circumscribed choroidal hemangioma ≤3 mm, although multiple sessions are sometimes required for PDT. For tumors >3 mm, PBT seems preferable because it can treat the tumor in only 1 session with better functional and anatomical outcomes.
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Sen M, Honavar SG. Circumscribed choroidal hemangioma: An overview of clinical manifestation, diagnosis and management. Indian J Ophthalmol 2019; 67:1965-1973. [PMID: 31755430 PMCID: PMC6896540 DOI: 10.4103/ijo.ijo_2036_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/10/2019] [Accepted: 11/12/2019] [Indexed: 11/12/2022] Open
Abstract
Circumscribed choroidal hemangioma is a benign vascular tumor which presents in middle-aged adults with progressive diminution of vision, metamorphopsia, floaters, and visual field defects. Diagnosis is based on the characteristic clinical features. It is an orange-red, usually solitary, tumor situated in the posterior pole. The visual symptoms are because of the associated subretinal fluid, cystoid macular edema, and, in long-standing cases, retinal pigment epithelium changes, subretinal fibrosis and retinoschisis. It must be distinguished from the more ominous amelanotic melanoma and choroidal metastasis. Diagnostic tools such as ultrasound, fundus fluorescein angiography, indocyanine green angiography, and optical coherence tomography are helpful in cases with diagnostic dilemma. Treatment is indicated in symptomatic cases. The management of choroidal hemangioma has evolved over the years beginning with laser photocoagulation to transpupillary thermotherapy, photodynamic therapy, plaque brachytherapy and external beam radiotherapy. No one therapeutic option holds superiority over the other. In this article, we review the epidemiology, clinical manifestations and treatment of the circumscribed variant of choroidal hemangioma.
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Affiliation(s)
- Mrittika Sen
- Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
| | - Santosh G Honavar
- Ocular Oncology Service, Centre for Sight, Hyderabad, Telangana, India
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The Role of Eye Plaque Brachytherapy and MR Imaging in the Management of Diffuse Choroidal Hemangioma: An Illustrative Case Report and Literature Review. Pract Radiat Oncol 2019; 9:e452-e456. [DOI: 10.1016/j.prro.2019.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/23/2022]
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Affiliation(s)
- Paul T Finger
- The New York Eye Cancer Center, New York City, New York, USA
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10
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Formisano M, Abdolrahimzadeh B, Mollo R, Bruni P, Malagola R, Abdolrahimzadeh S. Bilateral diffuse choroidal hemangioma in Sturge Weber syndrome: A case report highlighting the role of multimodal imaging and a brief review of the literature. J Curr Ophthalmol 2019; 31:242-249. [PMID: 31317109 PMCID: PMC6612038 DOI: 10.1016/j.joco.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To present a patient with bilateral choroidal hemangioma in Sturge-Weber syndrome (SWS) and highlight multimodal imaging techniques for early detection and management of ocular alterations. METHODS A 37-year-old woman with diagnosis of SWS presented to our unit. The patient had been treated with pulsed dye laser for bilateral nevus flammeus and had right leptomeningeal angiomatosis. She had glaucoma, but ultrasound biomicroscopy did not show anterior chamber or ciliary body alterations. RESULTS Enhanced depth imaging (EDI) spectral domain optical coherence tomography (SD-OCT) showed bilateral diffuse choroidal hemangiomas in both eyes with choroidal thickness above 1000 μm. B-scan ultrasound examination showed diffuse choroidal hemangioma in both eyes, with a choroidal thickness of 1.53 mm and 1.94 mm in the right and left eye (RE, LE), respectively. Peripapillary retinal nerve fiber evaluation showed thinning of the retinal nerve fiber layer in both eyes. CONCLUSIONS This report highlights multimodal imaging techniques for the critical assessment of patients with SWS, especially in rare cases with bilateral choroidal hemangioma of the choroid. Novel imaging modalities enable optimal management and follow-up of rare conditions, and our case adds further evidence to the existing literature.
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Affiliation(s)
| | | | - Roberto Mollo
- Ophthalmology Unit, Sapienza University of Rome, Rome, Italy
| | - Pietro Bruni
- Ophthalmology Unit, Sapienza University of Rome, Rome, Italy
| | | | - Solmaz Abdolrahimzadeh
- Ophthalmology Unit, NESMOS Department, Sapienza University of Rome, St. Andrea Hospital, Rome, Italy
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Cennamo G, Rossi C, Breve MA, Velotti N, Farella A, Liuzzi R, Cennamo G. Evaluation of vascular changes with optical coherence tomography angiography after ruthenium-106 brachytherapy of circumscribed choroidal hemangioma. Eye (Lond) 2018; 32:1401-1405. [PMID: 29773881 DOI: 10.1038/s41433-018-0100-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 03/03/2018] [Accepted: 03/19/2018] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To describe the vascular changes of circumscribed choroidal hemangioma (CCH) after ruthenium-106 brachytherapy using optical coherence tomography angiography (angio-OCT). METHODS Seven eyes of 7 patients diagnosed with symptomatic CCH who underwent ruthenium-106 plaque radiotherapy were included in the study. Patients underwent complete ophthalmic examination, bulbar echography and angio-OCT. The same protocol was applied 1 year after ruthenium-106 brachytherapy. RESULTS At baseline, the mean best-corrected visual acuity (BCVA) in affected eyes was 0.67 ± 0.14 logMAR, and the mean tumor thickness was 4.46 ± 0.91 mm measured by standardized A-scan echography. After ruthenium-106 plaque treatment, the mean BCVA increased to 0.17 ± 0.10 logMAR (p = 0.001) and the mean tumor thickness to 2.29 ± 0.71 mm (p = 0.003). Moreover, there was a significant reduction of the tumor basal diameter (p= 0.009). Intra-tumor angio-OCT measurements revealed a statistically significant reduction of the vessel and flow areas (p = 0.006 and p = 0.002, respectively) 1 year after brachytherapy. CONCLUSIONS Angio-OCT is a non-invasive reliable method with which to evaluate the vascular features of CCH and consequently to monitor changes after conservative treatment.
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Affiliation(s)
- Gilda Cennamo
- Eye Clinic, Department of Public Health, University of Naples Federico II, Naples, Italy.
| | - Claudia Rossi
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Maria Angelica Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Nunzio Velotti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Farella
- Functional and Morphologic Department of Radiotherapy and Legal Medicine, University of Naples "Federico II", Naples, Italy
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Research Council (CNR), Naples, Italy
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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Papastefanou VP, Plowman PN, Reich E, Pavlidou E, Restori M, Hungerford JL, Arora AK, Cohen VML, Sagoo MS. Analysis of Long-term Outcomes of Radiotherapy and Verteporfin Photodynamic Therapy for Circumscribed Choroidal Hemangioma. Ophthalmol Retina 2018; 2:842-857. [PMID: 31047538 DOI: 10.1016/j.oret.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/24/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the long-term therapeutic outcome for different treatments of circumscribed choroidal hemangioma (CCH). DESIGN Retrospective observational study. SUBJECTS Patients with newly diagnosed CCH. METHODS Observation, verteporfin (Visudyne) photodynamic therapy (PDT), lens-sparing external beam radiotherapy (LS-EBRT), or plaque brachytherapy. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) at baseline and throughout follow-up, tumor dimensions, and OCT central thickness (where available) at baseline and throughout follow-up were recorded. RESULTS There were 60 treatment-naïve consecutive cases with CCH between January 2000 and June 2014; 42 (70%) received treatment. These were LS-EBRT (23/60 [38%]; mean follow-up, 45.5 months), PDT (16/60 [27%]; mean follow-up, 38 months), and plaque radiotherapy (3/60 [5%]; mean follow-up, 92 months). Macular location, mottled or orange pigment, and absence of drusen were significantly more frequent in the treatment group. In the LS-EBRT group, median thickness reduction on ultrasound B scan was 1.6 mm (mean ± standard deviation, 1.65±1.6; range, -6.5 to +0.7). The mean ± standard deviation BCVA gain was 0.22±0.34, with >3 Snellen lines in 48% of cases. Kaplan-Meier estimates were 80% for any gain and 40% for >3 Snellen lines gain at 5 years. In the PDT group, the median decrease in thickness was 0.95 mm (mean ± standard deviation, 1.0±0.8; range, -2.5 to +0.2). The mean ± standard deviation BCVA gain was at 0.3±0.51, with >3 Snellen lines in 30% of cases. Kaplan-Meier estimates were 93% for any gain and 68% for >3 Snellen lines at 5 years. Double versus single duration PDT had more favorable outcomes with a greater reduction in tumor thickness (P = 0.04), central retinal thickness (P = 0.02), and improvement in visual acuity (median, 0.33 vs -0.05). There was no difference in decrease in tumor thickness or BCVA gain between the LS-EBRT and PDT groups. With plaque brachytherapy, the mean decrease in thickness was 2.5 mm, but BCVA loss of >2 Snellen lines was noted in all 3 cases at the end of follow-up. Radiation complications developed in 10 of 23 cases (43.5%) from the LS-EBRT group and 2 of 3 cases (67%) from the plaque brachytherapy group. CONCLUSIONS LS-EBRT is equivalent to PDT in CCH management for post-treatment BCVA and tumor thickness reduction. The risk of LS-EBRT and plaque brachytherapy was late radiation-related complications. Double duration PDT was more favorable than single duration.
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Affiliation(s)
| | - P Nicholas Plowman
- Department of Radiation Oncology, St. Bartholomew's Hospital, London, UK
| | | | | | - Marie Restori
- Ultrasound Department, Moorfields Eye Hospital, London, UK
| | | | | | | | - Mandeep S Sagoo
- Ocular Oncology Service, London, UK; UCL Institute of Ophthalmology, London, UK
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Berry M, Lucas LJH. Circumscribed choroidal hemangioma: A case report and literature review. JOURNAL OF OPTOMETRY 2017; 10:79-83. [PMID: 26872405 PMCID: PMC5383459 DOI: 10.1016/j.optom.2015.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/23/2015] [Accepted: 12/23/2015] [Indexed: 05/12/2023]
Abstract
Choroidal hemangioma is a rare congenital ocular tumor that can present as either circumscribed or diffuse. Circumscribed choroidal hemangioma (CCH) typically manifests as a red-orange mass within the posterior pole and appears similar to other ocular conditions, such as choroidal melanoma and choroidal metastasis. Proper diagnosis is crucial and is aided by the use of ancillary testing. CCH itself is benign but can cause secondary complications such as subretinal fluid accumulation and subsequent retinal detachment. If these conditions should arise, several treatment options are available.
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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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Circumscribed Choroidal Hemangioma. Retina 2013. [DOI: 10.1016/b978-1-4557-0737-9.00153-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Photodynamic therapy in the management of circumscribed choroidal hemangioma. Can J Ophthalmol 2012; 47:16-20. [DOI: 10.1016/j.jcjo.2011.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 07/17/2011] [Accepted: 08/17/2011] [Indexed: 11/22/2022]
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Turell ME, Singh AD. Vascular tumors of the retina and choroid: diagnosis and treatment. Middle East Afr J Ophthalmol 2011; 17:191-200. [PMID: 20844673 PMCID: PMC2934709 DOI: 10.4103/0974-9233.65486] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The vascular tumors of the retina and choroid comprise a diverse group of congenital and acquired lesions. The major vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, retinal vasoproliferative tumor, and racemose hemangiomatosis of the retina or Wyburn–Mason syndrome. Choroidal vascular tumors include circumscribed choroidal hemangioma and diffuse choroidal hemangioma. While classified as benign, visual symptoms secondary to exudative retinal detachment and a variety of other mechanisms are common and are a major source of long-term visual disability. While many therapeutic modalities exist, treatment of symptomatic cases can be challenging. Of particular importance, many of the vascular tumors of the retina and choroid have significant associations with systemic disease. As ocular symptoms are often the most common presenting disease manifestation, the ophthalmologist plays an important role in accurate and early diagnosis. The ability to initiate prompt screening and treatment in appropriate cases is critical. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.
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Affiliation(s)
- Mary E Turell
- Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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Standard versus Bolus Photodynamic Therapy in Circumscribed Choroidal Hemangioma: Functional Outcomes. Eur J Ophthalmol 2011; 21:452-8. [DOI: 10.5301/ejo.2011.6263] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2010] [Indexed: 11/20/2022]
Abstract
Purpose TO compare standard versus bolus photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). Methods Twenty consecutive cases of CCH were included in this prospective randomized study. Each patient was randomly assigned to receive either standard PDT (10-minute 6 mg/mq2 verteporfin infusion; treatment at 15 min; 50 J/cm2; 83 s) or bolus PDT (6 mg/mq2 verteporfin infusion bolus in 1 min; treatment at 5 min; 100 J/cm2; 166 s). Best-corrected visual acuity (BCVA), fundus photography, optical coherence tomography, fluorescein, and indocyanine green angiography were performed at baseline and during follow-up. Retinal sensitivity was tested with microperimetry before and after treatment. Follow-up was longer than 32 months. Results Mean follow-up was 58±11 months. All cases (100%) showed clinical regression of the treated lesion. Neuroretinal and retinal pigment epithelium (RPE) changes were found in 9 (90%) bolus PDT over treated area. No similar RPE changes were found in patients treated with standard PDT. There was a no statistically significant difference in BCVA outcome between the 2 groups (p=0.078). Microperimetry revealed reduced sensitivity over the treated area in 7 bolus PDT vs 1 in standard treated eyes (p=0.008). Conclusions Both standard and bolus PDT induce regression of symptomatic CCH. Bolus PDT may cause RPE and retinal changes associated with reduced retinal sensitivity.
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Photodynamic therapy of choroidal hemangioma in sturge-weber syndrome, with a review of treatments for diffuse and circumscribed choroidal hemangiomas. Surv Ophthalmol 2010; 56:68-85. [PMID: 21074819 DOI: 10.1016/j.survophthal.2010.08.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 07/30/2010] [Accepted: 08/03/2010] [Indexed: 11/23/2022]
Abstract
We report three new cases of patients with Sturge-Weber Syndrome and symptomatic retinal detachments from diffuse choroidal hemangiomas successfully treated with photodynamic therapy (PDT) and review medical literature on the available treatment options for choroidal hemangiomas. All patients were treated with a single session of PDT with verteporfin infused at a concentration of 6 mg/m(2) and treated for 83 seconds with 689-nm Zeiss laser that was delivered with total energy level of 50 J/cm(2) with an intensity of 600 mW/cm(2). The exudative retinal detachment (RD) and macular edema completely resolved in all cases by 1-4 months after PDT treatment. Visual acuity improved in all three cases with diminished tumor size in the areas of treatment. One case was followed for 5 months, another for 2 years, and the third case for 6 years, with no recurrence of exudative RD. PDT is an effective treatment option for visual deterioration from exudative retinal detachment in patients with diffuse choroidal hemangiomas.
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Kim YT, Kang SW, Lee JI. Gamma knife radiosurgery for choroidal hemangioma. Int J Radiat Oncol Biol Phys 2010; 81:1399-404. [PMID: 20950946 DOI: 10.1016/j.ijrobp.2010.08.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 07/23/2010] [Accepted: 08/06/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE Patients with choroidal hemangioma (CH), a benign ocular hamartoma, frequently presents with visual disturbance as a result of exudative retinal detachment (RD), which originates in subretinal fluid accumulation. We report our experience using the Leksell Gamma Knife in the management of symptomatic CH. METHODS AND MATERIALS Seven patients with symptomatic CH (circumscribed form in 3 patients and diffuse form in 4) were treated with the Leksell Gamma Knife at our institution during a 7-year period. All patients presented with exudative RD involving the macula that resulted in severe visual deterioration. The prescription dose to the target margin was 10 Gy in all cases. The mean tumor volume receiving the prescription dose was 536 mm3 (range, 151-1,057). The clinical data were analyzed in a retrospective fashion after a mean follow-up of 34.4 months (range, 9-76). RESULTS The resolution of exudative RD was achieved within 6 months, and the visual acuity of the affected eye had improved at the latest follow-up examination (p=.018) in all patients. No recurrence of exudative RD occurred. Thinning of the CHs was observed in most patients; however, symptomatic radiation toxicity had not developed in any of the patients. CONCLUSION Symptomatic CHs can be safely and effectively managed with Gamma Knife radiosurgery using a marginal dose of 10 Gy.
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Affiliation(s)
- Yun Taek Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Yim JFL, Sandinha T, Kerr JM, Ritchie D, Kemp EG. Treatment review of sight threatening circumscribed choroidal haemangioma. Int J Ophthalmol 2010; 3:168-71. [PMID: 22553545 DOI: 10.3980/j.issn.2222-3959.2010.02.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 05/26/2010] [Indexed: 11/02/2022] Open
Abstract
AIM To describe our clinical experience in treating circumscribed choroidal haemangioma (CCH) in a tertiary referral centre over a fifteen year period prior to photodynamic therapy. METHODS The departmental database and photographic records of a tertiary referral center were used to identify patients who were treated for CCH between 1992 and 2007. Their case records were reviewed. RESULTS Visual acuity improved (>2 Snellen lines) in eleven patients (69%) remained stable in one patient (6%) and deteriorated in four patients (25%). Six of the seven treated with brachytherapy and three of the four treated with transpupillary thermotherapy achieved better visual acuity after treatment. 86% of patients treated within six months of onset of symptoms and 50% of patients treated after six months of onset of symptoms noted an improvement in visual acuity. Only one patient in our series had a final VA of 6/60 or worse. Mean follow-up was thirty-five months. CONCLUSION Visual outcome is better when treatment is performed within 6 months of symptoms. The majority of patients achieved an improvement in visual acuity without any adverse effect following treatment.
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Abstract
PURPOSE To review recent advances in the diagnosis and treatment of congenital vascular malformations of the retina and choroid. METHODS Review of the current literature on retinal haemangioblastoma, racemose haemangiomatosis, retinal cavernous haemangioblastoma, circumscribed choroidal haemangioma, and diffuse choroidal haemangioma. CONCLUSION The management of patients with congenital vascular lesions of the retina and choroid is advancing rapidly through recent developments in genetic testing, ocular imaging, and treatment. Most are associated with systemic disease, which may be life-threatening. New therapeutic methods such as Verteporfin photodynamic therapy and anti-angiogenic therapy have significantly improved the treatment of retinal and choroidal angiomas and vascular malformations. Ophthalmologists have a major role in detecting and diagnosing these tumours and in providing long-term care in collaboration with a specialist in the field.
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Augsburger JJ, Anand R, Sanborn GE. Choroidal Hemangiomas. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Höcht S, Wachtlin J, Bechrakis NE, Schäfer C, Heufelder J, Cordini D, Kluge H, Foerster M, Hinkelbein W. Proton or photon irradiation for hemangiomas of the choroid? A retrospective comparison. Int J Radiat Oncol Biol Phys 2006; 66:345-51. [PMID: 16887287 DOI: 10.1016/j.ijrobp.2006.04.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2006] [Accepted: 04/14/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to compare, on a retrospective basis, the results of therapy in patients with uveal hemangioma treated with photon or proton irradiation at a single center. METHODS From 1993 to 2002 a total of 44 patients were treated. Until 1998 radiotherapy was given with 6 MV photons in standard fractionation of 2.0 Gy 5 times per week. In 1998 proton therapy became available and was used since then. A dose of 20 to 22.5 Cobalt Gray Equivalent (CGE) 68 MeV protons was given on 4 consecutive days. Progressive symptoms or deterioration of vision were the indications for therapy. RESULTS Of the 44 patients treated, 36 had circumscribed choroidal hemangiomas and 8 had diffuse choroidal hemangiomas (DCH) and Sturge-Weber syndrome. Of the patients, 19 were treated with photons with a total dose in the range of 16 to 30 Gy. A total of 25 patients were irradiated with protons. All patients with DCH but 1 were treated with photons. Stabilization of visual acuity was achieved in 93.2% of all patients. Tumor thickness decreased in 95.4% and retinal detachment resolved in 92.9%. Late effects, although generally mild or moderate, were frequently detected. In all, 40.9% showed radiation-induced optic neuropathy, maximum Grade I. Retinopathy was found in 29.5% of cases, but only 1 patient experienced more than Grade II severity. Retinopathy and radiation-induced optic neuropathy were reversible in some of the patients and in some resolved completely. No differences could be detected between patients with circumscribed choroidal hemangiomas treated with protons and photons. Treatment was less effective in DCH patients (75%). CONCLUSIONS Radiotherapy is effective in treating choroidal hemangiomas with respect to visual acuity and tumor thickness but a benefit of proton therapy could not be detected. Side effects are moderate but careful monitoring for side effects should be part of the follow-up procedures.
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Affiliation(s)
- Stefan Höcht
- Clinic for Radiation Oncology and Radiotherapy, Department for Ophthalmology, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Singh AD, Kaiser PK, Sears JE, Gupta M, Rundle PA, Rennie IG. Photodynamic therapy of circumscribed choroidal haemangioma. Br J Ophthalmol 2004; 88:1414-8. [PMID: 15489484 PMCID: PMC1772380 DOI: 10.1136/bjo.2004.044396] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To evaluate efficacy of verteporfin ocular photodynamic therapy (PDT) in treatment of 10 patients with a symptomatic circumscribed choroidal haemangioma. DESIGN Prospective non-randomised, interventional case series and critical review of previously published studies. METHODS 10 consecutive patients (seven primary, two failed transpupillary thermotherapy (TTT), and one failed external beam radiotherapy) with symptomatic circumscribed choroidal haemangioma were treated using verteporfin 6 mg/m2 given as an intravenous infusion over 10 minutes. Diode laser (690 nm) with an intensity of 600 mW/cm2 for 83 seconds (50 J/cm2) was applied 5 minutes after completion of infusion. Single or multiple partially overlapping spots were applied based on the tumour basal dimensions. Periodic follow up with ophthalmoscopy, ultrasonography, and angiographic studies was performed. RESULTS All 10 patients showed evidence of regression with flattening of tumour, resolution of subretinal fluid, and reduction of choroidal vasculature on angiograms. The visual acuity either improved or remained stable in eight (80%) patients. Visual loss due to delayed choroidal atrophy was seen in two patients. CONCLUSIONS Although verteporfin PDT is an effective treatment for management of symptomatic circumscribed choroidal haemangioma, delayed treatment related effects can lead to visual loss.
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Affiliation(s)
- A D Singh
- Department of Ophthalmic Oncology, Cole Eye Institute (i3-129), Cleveland Clinic Foundation, 9500 Euclid Avenue, OH 44195, USA.
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