Transpupillary thermotherapy in the management of juxtapapillary and parafoveal circumscribed choroidal hemangioma

Abstract

Background: Circumscribed choroidal hemangioma (CCH) is a rare, vascular tumor that may be associated with formation of subretinal fluid, cystic retinal degeneration, and serous retinal detachment. Studies have suggested that proximity of this tumor to the fovea or optic nerve precludes the use of transpupillary thermotherapy (TTT) for treatment. We report our experience using TTT in managing patients with juxtapapillary and parafoveal CCH. Methods: We reviewed the records of consecutive patients with CCH treated by TTT at Princess Margaret Hospital,Toronto, between November 1999 and March 2003. This resulted in 11 eyes of 11 patients with juxtapapillary or parafoveal tumors. Treatment was delivered via slit lamp using an 810 nm diode laser with 350 to 800 mW,a 3.0 mm spot, and duration range from 5 s to 90 s. Outcome measures were reduction in tumor thickness, resolution of serous fluid, tumor control, visual acuity, and complications of treatment. Results: Mean age of patients was 47.6 years. Symptoms included blurred vision, metamorphopsia, light flashes, and floaters. Macular and optic disk edema, field defect, presence of subretinal fluid, and retinal detachment were noted. At presentation, Snellen visual acuity ranged from 20/70 to hand motions. Mean tumor base diameter was 6.0 mm and tumor thickness at baseline was 3.0 mm. Mean follow-up was 18.0 months. Post-TTT, mean tumor thickness was 2.8 mm. Macular and optic disk edema resolved in the majority of patients. Partial regression of the tumor was noted in 4 cases (36%) and good tumor control in 9 cases (82%). Visual acuity improved in 6 patients (55%). Interpretation: TTT can be effective for treating juxtapapillary and parafoveal CCH. Proximity to the fovea and optic nerve may not be predictive of poor post-treatment visual acuity, although statistical analysis with a larger sample size would more clearly demonstrate a clear advantage.