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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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Alshehri WM, AlAhmadi BO, Alhumaid F, Khoshhal MS, Khawaji ZY, AlHabuobi H, Alosaimi AM, Alkhathami A, Alorainy J. Safety and Efficacy of Photodynamic Therapy in the Treatment of Circumscribed Choroidal Hemangioma: A Systematic Review. Cureus 2023; 15:e50461. [PMID: 38222120 PMCID: PMC10786325 DOI: 10.7759/cureus.50461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Circumscribed choroidal hemangioma (CCH) is a sort of non-malignant hamartomatous tumor that occurs in the choroidal layer of the eye. It is a rare condition that affects people between their second and fourth decades of life, leading to significant deterioration of vision. One of the most catastrophic consequences of CCH is exudative retinal detachment (ERD), which has a severe impact on vision. This review aims to comprehensively assess the safety and efficacy of photodynamic therapy (PDT) using verteporfin as a therapeutic approach. Using the eligibility criteria, we analyzed the findings of 18 published articles from PubMed, Web of Science, Scopus, and Cochrane. The standard PDT protocol was used in all included studies, except two (one used half-dose, the other one used the double-dose) with an average of 1-2 sessions. PDT induced substantial tumor regression, with a mean thickness range from 0 to 2.3 mm. However, this contrasted with a previous study that reported a thickness of 3.46 mm as an indication of PDT failure. The mean tumor diameter varied from 4.8 mm to total tumor flattening. A suboptimal effect with a mean diameter ranging from 6mm to 8mm was found in two clinical studies. Significant improvement in vision was observed during the last follow-up, ranging from a normalization of Best Corrected Visual Acuity (BCVA) 20/20 to 20/80; counting finger vision persisted in two patients even after treatment. PDT successfully achieved complete subretinal fluid (SRF) resolution in 14 studies and resolved ERD in nine articles. Most studies did not report serious adverse events, but some reported macular atrophy, microcystic degeneration of the retina, transient visual disturbances, Retinal pigmented epithelium (RPE) metaplasia, and cystic degeneration of the retina. This systemic review demonstrated PDT's effectiveness and safety as a first-line management modality for CCH. Photodynamic therapy efficiently induced tumor regression, resulting in a notable reduction in both tumor diameter and thickness, with optimal efficacy to improve vision and resolution of the consequences of CCH, such as SRF and ERD.
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Affiliation(s)
| | - Badr O AlAhmadi
- Ophthalmology, Prince Mohammed bin Abdulaziz Hospital, Madinah, SAU
| | - Fatima Alhumaid
- Ophthalmology, Imam Abdulrahman Bin Faisal University, Alkhobar, SAU
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Stehouwer M, Schlingemann RO, Verbraak FD. High recurrence rate in patients with choroidal hemangioma treated with limited single spot photodynamic therapy during long-term follow-up. Acta Ophthalmol 2020; 98:679-686. [PMID: 32286734 PMCID: PMC7687154 DOI: 10.1111/aos.14409] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 02/24/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the long-term follow-up of patients with a circumscribed choroidal hemangioma (CCH) treated with limited single spot photodynamic therapy (PDT) at the Amsterdam University Medical Center, location AMC (AUMC). METHODS This cross-sectional study included 17 patients, treated between 2001 and 2012. Evaluation included best corrected visual acuity, slitlamp examination, fundoscopy, ophthalmic ultrasonography (USG), fluorescein/indocyanine green angiography (FA/ICG), fundus autofluorescence (FAF) and optical coherence tomography (OCT). PRIMARY OUTCOME recurrence rate, secondary outcomes: long-term functional and structural changes. RESULTS An unexpected high recurrence rate of 35% (n6) was found with a mean follow-up time between treatment and recurrence of almost 6 years, range 2.8-10.7 years. With a recurrence, the classical CCH pattern was no longer recognizable on FA or ICG. Signs of leakage were best observed with OCT, and the recurrence could be confirmed with USG. Retreatment with PDT of all recurrences was successful. After a successful initial PDT, the achieved visual acuity (VA) showed a small decrease over time, median VA from 0.10 LogMar to 0.15 LogMar (p 0.09) after a mean follow-up of 11.36 years (range 5.1-15.5 years). During follow-up study visit, the OCT revealed a slightly increased thickness of the choroid in 86% of cases at the site of the original tumour, without a clear correlation to the recurrences. CONCLUSION Limited single spot PDT is a safe and effective treatment for CCH preserving a good VA. However, because of the relatively high recurrence rate found in this study, we recommend regular follow-up with OCT every 6 months.
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Affiliation(s)
- Marilette Stehouwer
- Department of OphthalmologyAmsterdam University Medical CentersLocation AMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of OphthalmologySt Antonius HospitalNieuwegeinThe Netherlands
| | - Reinier O. Schlingemann
- Department of OphthalmologyAmsterdam University Medical CentersLocation AMCUniversity of AmsterdamAmsterdamThe Netherlands,Department of OphthalmologyUniversity of LausanneJules‐Gonin Eye HospitalLausanneSwitzerland
| | - Frank D. Verbraak
- Department of OphthalmologyAmsterdam University Medical CentersLocation VUmcUniversity of AmsterdamAmsterdamThe Netherlands
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Murro V, Mucciolo DP, Giorgio D, Sodi A, Donati MC, Giacomelli G, Virgili G, Mazzini C, Giansanti F. Long-term follow-up and "double layer sign" in patients affected by circumscribed choroidal hemangioma. Photodiagnosis Photodyn Ther 2020; 31:101960. [PMID: 32818639 DOI: 10.1016/j.pdpdt.2020.101960] [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: 05/26/2020] [Revised: 07/21/2020] [Accepted: 08/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Photodynamic therapy has revolutionised the treatment of circumscribed choroidal hemangiomas. The aim of this report is to report the long-term follow-up of patients affected by circumscribed choroidal hemangioma treated using photodynamic therapy. MATERIALS AND METHODS We retrospectively reviewed patients affected by circumscribed choroidal hemangioma examined at the Retinal Medical Department at the Eye Clinic in Florence. We studied circumscribed choroidal hemangiomas treated using photodynamic therapy with at least 1 follow-up examination. Verteporfin was administered intravenously for 10 min (6 mg/m2 body surface area). After infusion (5 min), a 689 nm laser was applied with a light dose of 50 J/cm2. RESULTS Ten eyes of 10 patients with circumscribed choroidal hemangioma who underwent Photodynamic therapy were included in our series (2 females and 8 males; average age at diagnosis 47.8 ± 9.3 yrs.; age range: 27-56 years). Five patients (5/10; 50 %) received only the photodynamic treatment whereas 5 patients (5/10; 50 %) also received other treatments (laser photocoagulation, intravitreal injection). On average, the patients received 2 photodynamic treatments (range 1-4). Four patients (4/10, 40 %) had a > 5-year follow-up; (average 4.5 ± 3.7 yrs. range 6 months - 10 years). In 2 patients we identified the "double layer sign" at the optical coherence tomography examination on circumscribed choroidal hemangioma. CONCLUSIONS In our series, photodynamic therapy was a safe and effective treatment for circumscribed choroidal hemangioma during long-term follow-up. The double layer sign, which can be detected in several choroidal pathologies, suggests common pathogenetic mechanisms for circumscribed choroidal hemangiomas and central serous chorioretinopathy/polypoidal choroidopathy spectrum disease.
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Affiliation(s)
- Vittoria Murro
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Dario Pasquale Mucciolo
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Dario Giorgio
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Andrea Sodi
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Maria Carla Donati
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Giovanni Giacomelli
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Gianni Virgili
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Cinzia Mazzini
- Unit of Ocular Oncology, Careggi Teaching Hospital, Largo Brambilla, 3 - 50134, Florence, Italy
| | - Fabrizio Giansanti
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla, 3 - 50134, Florence, Italy
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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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Tian C, Chen X, Cao J, Yang L. Application of ICG-enhanced thermocoagulation method and photodynamic therapy in circumscribed choroidal hemangioma. Oncol Lett 2018; 15:5760-5766. [PMID: 29556306 PMCID: PMC5844072 DOI: 10.3892/ol.2018.8056] [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: 09/14/2017] [Accepted: 01/19/2018] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to compare the effect of indocyanine green (ICG)-enhanced laser (810 nm) thermocoagulation method and photodynamic therapy (PDT) on circumscribed choroidal hemangioma (CCH). A total of 36 patients (36 pair of eyes) diagnosed with CCH in the Ocular Fundus Disease Center of The Affiliated Hospital of Medical College of Ningbo University from June 2010 to January 2016 were selected and randomly divided into two groups. ICG-enhanced thermocoagulation was used to treat 18 patients (18 pair of eyes), and PDT was used to treat the remaining 18 patients (18 pair of eyes). The best corrected visual acuity of the affected eyes was observed before and after treatment, and changes in the tumor were observed through ocular fundus photochromes under the ophthalmoscope. The changes in tumor size and height were examined through B-scan ultrasonography. The changes in serous retinal fluid were examined by optical coherence tomography (OCT). A total of 36 patients were followed-up for 3, 7, 11 and 24 weeks after laser therapy with an average of 18 weeks. It was seen that the subretinal serous exudation disappeared in 36 patients through the fundus examination after treatment, and B-scan ultrasonography showed that the tumor size was reduced. Among 18 patients undergoing ICG-enhanced thermocoagulation treatment, the visual acuity of 72.2% of them was improved, while that of the remaining 27.8% was stable, and there were no patients with decreased visual acuity; the fundus observation showed that when tumor atrophy occurred, the tumor turned white accompanied with mild pigment disorders, but retinal and choroidal normal vessels were not damaged. Among 18 patients undergoing PDT treatment, the visual acuity of 44.4% was increased, that of 50% was stable, and that of 5.6% of the patients was decreased; through fundus observation, tumor atrophy scars and alignment, a large number of hyperplasia or pigment loss and partial vascular occlusion could be seen. The results indicated that in the treatment of CCH, ICG-enhanced laser (810 nm) thermocoagulation and PDT can lead to tumor atrophy and promote the absorption of exudation. However, the damage of ICG-enhanced laser thermocoagulation to normal fundus tissues is significantly smaller than that of PDT, and the former has higher safety.
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Affiliation(s)
- Chuan Tian
- Department of Ophthalmology, The Affiliated Hospital of Medical College of Ningbo University, Jiangbei, Ningbo, Zhejiang 315020, P.R. China
| | - Xi Chen
- Department of Ophthalmology, The Affiliated Hospital of Medical College of Ningbo University, Jiangbei, Ningbo, Zhejiang 315020, P.R. China
| | - Jin Cao
- Department of Ophthalmology, The Affiliated Hospital of Medical College of Ningbo University, Jiangbei, Ningbo, Zhejiang 315020, P.R. China
| | - Lu Yang
- Department of Ophthalmology, The Affiliated Hospital of Medical College of Ningbo University, Jiangbei, Ningbo, Zhejiang 315020, P.R. China
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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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Süsskind D, Inhoffen W, Gelisken F, Völker M. Photodynamic therapy with double duration for circumscribed choroidal haemangioma: functional and anatomical results based on initial parameters. Clin Exp Ophthalmol 2017; 46:495-501. [PMID: 29131474 DOI: 10.1111/ceo.13096] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 11/27/2022]
Abstract
IMPORTANCE Pre-treatment symptoms longer than 12 months and foveal cystoid changes are indicators for poor anatomical and functional outcome after photodynamic therapy (PDT). BACKGROUND To evaluate the prognostic factors on the effectiveness of PDT with double duration for treatment of exudative circumscribed choroidal haemangioma. DESIGN Retrospective study. PARTICIPANTS Twenty-seven patients with symptomatic exudative circumscribed choroidal haemangioma treated with PDT. METHODS Clinical charts of patients with exudative circumscribed choroidal haemangioma treated with PDT were analysed with regard to visual acuity, duration of symptoms, subfoveal fluid, foveal cystoid changes and foveal thickness in optical coherence tomography. MAIN OUTCOME MEASURES Change of best-corrected visual acuity, sub- and intrafoveal fluid and foveal thickness measured with optical coherence tomography from baseline to last follow-up. RESULTS Mean visual acuity improved by 0.05 from 0.42 logMAR (standard deviation [SD] 0.34) to 0.37 logMAR (SD 0.47). In 70% of the patients, PDT stopped exudation and revealed a dry fovea. The recurrence or persistence of sub- or intrafoveal fluid was significantly associated with pre-therapeutic symptoms existing for more than 12 months (P = 0.046). Mean foveal thickness in optical coherence tomography decreased from 324 μm (SD 223 μm) to 209 μm (SD 109 μm). CONCLUSIONS AND RELEVANCE PDT proved to be a safe and effective treatment procedure for exudative circumscribed choroidal haemangioma in our series, with few side effects. We observed a more successful treatment with regard to anatomical and functional results in cases with pre-existing symptoms less than 12 months and in cases without pre-therapeutic foveal cystoid changes.
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Affiliation(s)
- Daniela Süsskind
- Department of Ophthalmology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Werner Inhoffen
- Department of Ophthalmology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Faik Gelisken
- Department of Ophthalmology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Michael Völker
- Department of Ophthalmology, Eberhard Karls University Tübingen, Tübingen, Germany
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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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Half-dosage and bolus injection photodynamic therapy for symptomatic circumscribed choroidal hemangioma: A case report. Photodiagnosis Photodyn Ther 2015; 12:526-9. [DOI: 10.1016/j.pdpdt.2015.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/20/2015] [Accepted: 05/07/2015] [Indexed: 11/19/2022]
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Cerman E, Çekiç O. Clinical use of photodynamic therapy in ocular tumors. Surv Ophthalmol 2015; 60:557-74. [PMID: 26079736 DOI: 10.1016/j.survophthal.2015.05.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 01/10/2023]
Abstract
Although the introduction of intravitreal anti-vascular endothelial growth factor drugs reduced the indications for photodynamic therapy in ophthalmology, it may still be used in various ocular tumors. Although many studies have shown that photodynamic therapy is effective in ocular tumors, the literature consists of case reports and series. In this review, we systematically performed a meta-analysis for the use of photodynamic therapy in circumscribed choroidal hemangioma, diffuse choroidal hemangioma, retinal capillary hemangioma, von Hippel-Lindau angiomatosis, choroidal melanoma, retinal astrocytoma, retinoblastoma, eyelid tumors, conjunctival tumors, and choroidal metastasis.
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Affiliation(s)
- Eren Cerman
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Osman Çekiç
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
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Abstract
PURPOSE To evaluate the effect of photodynamic therapy on amelanotic choroidal melanoma. METHODS Nine patients with posteriorly located amelanotic choroidal melanomas, one with a pigmented portion, underwent photodynamic therapy using verteporfin as the photosensitizing agent. The basal diameters ranged from 4 mm to 16 mm and the heights from 1.3 mm to 5.7 mm. Treatment was repeated until the melanoma was completely flat or its height had reached a stable end point. Tumor response was assessed by clinical examination, photography, and ultrasonography. Annual screening for hepatic metastases was performed. RESULTS Eight tumors demonstrated apparent complete regression over 1 month to 14 months. The amelanotic portion of the mixed tumor flattened, whereas the height of the pigmented part remained stable at 2 mm. In 8 patients there has been no recurrence during follow-up of between 34 months and 81 months. One case developed 2 separate local recurrences at 21 months and 34 months. There were no serious complications, no patient lost vision after treatment, and none developed metastatic disease. CONCLUSION In this series photodynamic therapy was highly effective in causing regression of posteriorly located amelanotic choroidal melanomas, without a detrimental effect on vision. While the short-term results are encouraging, there is some uncertainty regarding complete tumor destruction and long-term efficacy.
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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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Yin XL, Ye J, Yuan RD, Ji SX. A case of circumscribed choroidal hemangioma in Sturge-Weber syndrome in China. Int J Ophthalmol 2011; 4:210-1. [PMID: 22553645 DOI: 10.3980/j.issn.2222-3959.2011.02.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 02/18/2011] [Indexed: 11/02/2022] Open
Abstract
We present a case of circumscribed choroidal hemangioma (CCH) in Sturge-Weber syndrome in a 30-year-old woman with congenital port-wine stains on the left side of face involving the upper eyelid, cheek and the nose, and she had undergone facial hemangioma surgery 3 years ago suggestive of Sturge-Weber syndrome. She presented with a 1-month history of rapidly decreased visual acuity (VA) to counting fingers in the left eye which had no prior history of visual problem. And there was no evidence of glaucoma. At 3 months after the treatment of the standard photodynamic therapy (PDT) the VA was 20/200. For some reasons, we have no idea about the changes of tumor thickness and subretinal fluid. We confirmed the curative effect of PDT treatment for CCH because of the significantly improved VA in the bad eye.
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Affiliation(s)
- Xiao-Lei Yin
- Department of Ophthalmology, 305 Hospital of Chinese PLA, Beijing 100017, China
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Tuncer S, Demirci H, Shields CL, Shields JA. Polypoidal choroidal vasculopathy following photodynamic therapy for choroidal hemangioma. Eur J Ophthalmol 2009; 19:159-62. [PMID: 19123168 DOI: 10.1177/112067210901900127] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a case of circumscribed choroidal hemangioma (CCH) that responded to photodynamic therapy (PDT) but 3 years later developed polypoidal choroidal vasculopathy (PCV) with exudative retinopathy. METHODS Case report. RESULTS A 59-year-old woman with a juxtapapillary CCH in her left eye was treated with a single 83-second, 7.5 mm PDT laser spot at 689 nm (50 J/cm2) 15 minutes after the injection of intravenous verteporfin (6 mg/m2). Three years later, the patient presented with photopsia in her left eye. Fundus examination of the left eye showed CCH regressed completely to a flat atrophic scar. There was diffuse macular edema and exudative retinopathy along the inferotemporal vascular arcade. On indocyanine green angiography, there were hyperfluorescent dilated choroidal vessels inferior to the foveola with late staining and leakage consistent with PCV. Hypofluorescence superior and nasal to the optic disc at the site of the treated hemangioma, consistent with choroidal ischemia, was observed. She was treated with 1.25 mg (0.05 cc) intravitreal bevacizumab. After 21 months of follow-up, the exudative retinopathy and macular edema completely regressed. CONCLUSIONS PDT is an effective treatment for CCH. Side effects of PDT for CCH are rare but include PCV.
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Affiliation(s)
- S Tuncer
- Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
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16
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Stur M. Indikationen für photodynamische Therapie mit Verteporfin im Zeitalter der intravitrealen Therapie – eine Übersicht. SPEKTRUM DER AUGENHEILKUNDE 2008. [DOI: 10.1007/s00717-008-0294-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma. Ophthalmology 2008; 116:100-105.e1. [PMID: 18973950 DOI: 10.1016/j.ophtha.2008.08.029] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 08/10/2008] [Accepted: 08/12/2008] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To evaluate photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH). DESIGN Prospective, multicenter, nonrandomized clinical trial. PARTICIPANTS Thirty-one eyes of 31 patients with posterior pole CCH and symptoms caused by exudation into the macular area. INTERVENTION 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. MAIN OUTCOME MEASURES 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. FINANCIAL DISCLOSURE(S) The authors have no proprietary or commercial interest in any materials discussed in this article.
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Mennel S, Barbazetto I, Meyer CH, Peter S, Stur M. Ocular Photodynamic Therapy – Standard Applications and New Indications (Part 2). Ophthalmologica 2007; 221:282-91. [PMID: 17728549 DOI: 10.1159/000104757] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 03/23/2007] [Indexed: 11/19/2022]
Abstract
Photodynamic therapy (PDT) has become a well-established treatment for vascular forms of age-related macular degeneration (AMD). The implementation of evidence-based medicine principles into the treatment regimen of AMD seems to be immensly important, since AMD continues to be the most frequent cause of blindness among patients older than 65 years in industrialized countries. Numerous randomized prospective studies demonstrated high levels of evidence for the efficacy of various treatment approaches such as laser photocoagulation, PDT, subretinal surgery or novel anti-angiogenic drugs [Arch Ophthalmol 2006;124:597-599]. The high evidence shown by these studies supported the rationale to use PDT also in additional, less frequent, vasoproliferative diseases. Although these 'case series' and 'individual case control studies' have a low level of evidence, they give us important information for treatment decisions in these rare conditions. The goal of this survey is to review the current literature regarding PDT in vasoproliferative and exudative ocular diseases outside AMD. Many studies modified the treatment parameters of PDT to address the specific pathology of the underlying disease. Table 1 summarizes the diseases and treatment parameters that are described in this part 2, the entire table of this review is included in part 1 (www.karger.com/doi/10.1159/ 000101922).
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Affiliation(s)
- Stefan Mennel
- Department of Ophthalmology, Philipps University, Marburg, Germany.
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