Circumscribed Choroidal Hemangioma: Visual Outcome in the Pre-Photodynamic Therapy Era versus Photodynamic Therapy Era in 458 Cases

Abstract

To analyze visual outcomes after treatment of choroidal hemangioma in the pre-photodynamic therapy (PDT) era versus PDT era. Retrospective, comparative case series. A total of 458 patients with circumscribed choroidal hemangioma. Comparison of hemangioma managed in the pre-PDT (1967-2001) era versus PDT (2002-2018) era. Visual acuity outcome. A total of 458 tumors were treated over this 51-year period. A comparison (pre-PDT [n= 220 cases] vs. PDT [n= 238 cases]) revealed PDT era patients were of older mean age (48.9 vs. 53.8 years, P= 0.002) and were more likely to have systemic hypertension (17.7% vs. 33.8%, P < 0.001), tumor location in the macula (57.4% vs. 67.5%, P= 0.01), subretinal fluid on OCT (33.3% vs. 70.7%, P= 0.01), and greater extent of overlying lipofuscin (P= 0.001). Findings of tumor basal diameter and thickness and fluorescein and indocyanine green angiography were no different in the 2 eras. Treatment (pre-PDT vs. PDT) included argon laser photocoagulation (42.1% vs. 0.4%), PDT (0% vs. 43.8%), transpupillary thermotherapy (0% vs. 0.4%), plaque radiotherapy (7.0% vs. 5.2%), external beam radiotherapy (1.4% vs. 1.3%), enucleation (0.9% vs. 0.4%), and observation (48.6% vs. 47.6%). After treatment, patients in the PDT era demonstrated better mean logarithm of the minimum angle of resolution visual acuity (1.28 vs. 0.51, P < 0.001) (Snellen equivalent 20/400 vs. 20/63, P < 0.001). Final visual acuity was ≥20/40 for those with entering vision of ≥20/40 (59.6% vs. 74.7%, P= 0.001) and for those with entering vision of 20/50-20/200 (25.4% vs. 47.3%, P < 0.001). Management of choroidal hemangioma in the PDT era has allowed for significantly better visual outcome compared with the pre-PDT era, with mean final visual acuity of 20/400 (pre-PDT era) versus 20/63 (PDT era).