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Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma.

AbstractPURPOSE:
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.
AuthorsAnna Boixadera, José García-Arumí, José García Arumí, Vicente Martínez-Castillo, Jose Luis Encinas, Javier Elizalde, Gonzalo Blanco-Mateos, Jose Caminal, Carmela Capeans, Félix Armada, Amaparo Navea, Jose Luis Olea
JournalOphthalmology (Ophthalmology) Vol. 116 Issue 1 Pg. 100-105.e1 (Jan 2009) ISSN: 1549-4713 [Electronic] United States
PMID18973950 (Publication Type: Controlled Clinical Trial, Journal Article, Multicenter Study)
Chemical References
  • Coloring Agents
  • Photosensitizing Agents
  • Porphyrins
  • Verteporfin
  • Indocyanine Green
Topics
  • Adult
  • Aged
  • Choroid Neoplasms (diagnosis, drug therapy)
  • Coloring Agents
  • Female
  • Fluorescein Angiography
  • Hemangioma (diagnosis, drug therapy)
  • Humans
  • Indocyanine Green
  • Male
  • Middle Aged
  • Photochemotherapy
  • Photosensitizing Agents (therapeutic use)
  • Porphyrins (therapeutic use)
  • Prospective Studies
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Verteporfin
  • Visual Acuity

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