Treatment of circumscribed choroidal haemangioma in 2015

Abstract

PurposeTo assess local control and visual outcomes in patients treated for circumscribed choroidal hemangiomas either by photodynamic therapy (PDT) or proton beam therapy (PBRT) delivering 20 Gy (RBE) in 4 fractions after clip placement.Methodsthis single institution series included all consecutive patients (pts) treated between 1994 and 2014. Before 2006, PBRT was the sole treatment available with PDT starting in 2006 and becoming the first option with PBRT for select cases or relapses. Descriptive statistics were performed.ResultsThere were 48 patients, 32 males, 16 females. Twenty and 208 patients were treated with PBRT and PDT respectively. Median follow up was 44 months, longer for PBRT pts. Initial visual acuity (VA) was no different between the 2 groups. More patients undergoing PDT as first option underwent retreatment (PDT 9/28 with 1 or 2 salvage PDT and/or PBRT, PBRT 1/20 with one salvage PDT) (p = 0.023). There were more complications with PDT (macular atrophy 7, dsne 1, macular edema 2) than with PBRT (dep 5) (p = 0.006). Post treatment visual acuity was not significantly different between the 2 groups (VA ≥ 4 in 84% of PBRT pts, and 59% of PDT pts, p = 0.082). Post treatment thickness was better after PBRT (p = 0.014).ConclusionsPDT more frequently required retreatments. PBRT is more invasive than PDT but yields better local control rates. VA was similar between PDT and PBRT with a trend for better results with PBRT. VA after PBRT might be improved with lower doses per fraction; subsequently patients are now treated with 8 fractions up to 20 Gy (RBE).