Photodynamic therapy of circumscribed choroidal hemangioma: comparison of dosage and timing

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-minutes 6mg/mq2 verteporfin infusion; treatment at 15 min; 50 J/cm2; 83 sec) or bolus-PDT (6mg/mq2 verteporfin intravenously bolus in 2 min; treatment at 5 min; 100 J/cm2; 166 sec). All patients were treated with a single PDT application. Best correct visual acuity, fundus photography, optical coherence tomography, fluorescein and indocyanine green angiography were performed at baseline and at each follow-up examination. Retinal sensitivity was tested with microperimetry after treatment. Follow-up was longer than 24 months. Results Mean follow-up was 28 ± 4 months. All cases (100%) showed clinical regression of the treated lesion, complete resolution of subretinal fluid and reduction of choroidal leakage on angiograms. Cases treated with bolus-PDT showed retinal pigment epithelium (RPE) hyperplastic changes over treated area. No similar RPE changes were found in patients treated with standard PDT. Two patients treated with bolus-PDT developed macular pucker, respectively 4 and 5 months after treatment. Microperimetry examination revealed areas of reduced sensitivity after bolus-PDT compare to standard PDT (p<0.001). Conclusion Both standard and bolus-PDT seem effective in the treatment of symptomatic CCH. Bolus-PDT may cause reactive retinal changes impairing retinal sensitivity, whereas standard PDT never impairs (and sometimes restores) retinal function.