Circumscribed Choroidal Hemangioma Research Articles

PHOTODYNAMIC THERAPY-INDUCED ACUTE EXUDATIVE MACULOPATHY IN A CASE SERIES OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To describe the incidence, features, and clinical outcomes of photodynamic therapy-induced acute exudative maculopathy (PAEM) in circumscribed choroidal hemangioma. Prospective series of 10 patients who underwent standard-fluence photodynamic therapy for circumscribed choroidal hemangioma. Best-corrected visual acuity in the Early Treatment Diabetic Retinopathy Score and swept-source optical coherence tomography were performed before PDT and 3 days and 1 month after PDT. Central retinal thickness, circumscribed choroidal hemangioma retinal thickness, and subretinal fluid were measured. Photodynamic therapy-induced acute exudative maculopathy was considered as an increase ≥50 µ m in subretinal fluid or intraretinal fluid or the appearance of fibrin 3 days after photodynamic therapy. Six men and four women were included; median age was 55 years (19-69 years). The incidence rate of PAEM was 7 of 10. Five PAEM patients showed an increase in intraretinal fluid, two in subretinal fluid, and one developed abundant fibrin. Median best-corrected visual acuity at baseline was 57.5 letters (5-76 letters) being stable at 1 month (64 letters; 5-80) ( P = 0.03). Median central retinal thickness increased from 516 µ m (262-1,265 µ m) to 664.5 µ m after 3 days and diminished to 245 µ m after 1 month (156-1,363) ( P ≤ 0.022). In 6 of 7 of PAEM, a complete resolution of the fluid was obtained. Photodynamic therapy-induced acute exudative maculopathy was frequent in circumscribed choroidal hemangioma, although a favorable prognosis was observed in most cases.

Safety and Efficacy of Photodynamic Therapy in the Treatment of Circumscribed Choroidal Hemangioma: A Systematic Review.

Circumscribed choroidal hemangioma (CCH) is a sort of non-malignant hamartomatous tumor that occurs in the choroidal layer of the eye. It is a rare condition that affects people between their second and fourth decades of life, leading to significant deterioration of vision. One of the most catastrophic consequences of CCH is exudative retinal detachment (ERD), which has a severe impact on vision. This review aims to comprehensively assess the safety and efficacy of photodynamic therapy (PDT) using verteporfin as a therapeutic approach. Using the eligibility criteria, we analyzed the findings of 18 published articles from PubMed, Web of Science, Scopus, and Cochrane. The standard PDT protocol was used in all included studies, except two (one used half-dose, the other one used the double-dose) with an average of 1-2 sessions. PDT induced substantial tumor regression, with a mean thickness range from 0 to 2.3 mm. However, this contrasted with a previous study that reported a thickness of 3.46 mm as an indication of PDT failure. The mean tumor diameter varied from 4.8 mm to total tumor flattening. A suboptimal effect with a mean diameter ranging from 6mm to 8mm was found in two clinical studies. Significant improvement in vision was observed during the last follow-up, ranging from a normalization of Best Corrected Visual Acuity (BCVA) 20/20 to 20/80; counting finger vision persisted in two patients even after treatment. PDT successfully achieved complete subretinal fluid (SRF) resolution in 14 studies and resolved ERD in nine articles. Most studies did not report serious adverse events, but some reported macular atrophy, microcystic degeneration of the retina, transient visual disturbances, Retinal pigmented epithelium (RPE) metaplasia, and cystic degeneration of the retina. This systemic review demonstrated PDT's effectiveness and safety as a first-line management modality for CCH. Photodynamic therapy efficiently induced tumor regression, resulting in a notable reduction in both tumor diameter and thickness, with optimal efficacy to improve vision and resolution of the consequences of CCH, such as SRF and ERD.

Circumscribed Choroidal Hemangioma Simulating Choroidal Melanoma on Advanced Ultrawide-Field Pseudocolor Retinal Imaging: A Case Series

The purpose of this case series was to evaluate the features of circumscribed choroidal hemangioma on pseudocolor ultrawide-field (UWF) retinal images simulating choroidal melanoma and compare it to fundoscopic appearance. All four patients underwent full ophthalmological examination, including dilated fundus examination, ultrasonography, and UWF imaging (UWFI). All circumscribed choroidal hemangioma appeared clinically as orange-red choroidal lesions which were echodense with regular internal structure on ultrasonography. All lesions appeared green-grey in color on pseudocolor UWFI. Pseudocolor UWFI of circumscribed choroidal hemangioma represents distortion of true color appearance and may simulate choroidal melanoma. [Ophthalmic Surg Lasers Imaging Retina 2023;54:292-296.].

Half-Dose Photodynamic Therapy as a Novel Treatment Protocol for Circumscribed Choroidal Hemangioma.

We present a case series of four patients with circumscribed choroidal hemangioma (CCH) treated with half-dose PDT, proposing this as a novel treatment protocol. Four patients with CCH were included, and then evaluated using multimodal imaging, including optical coherence tomography (OCT), fluorescein angiography, indocyanine green angiography, fundus autofluorescence, and ultrasound following treatment with half-dose and full-fluence PDT. Following half-dose PDT, all patients showed significant shrinkage of the hemangioma, functional improvement, and decrease of intra- and sub-retinal fluid. All patients remained stable after a single PDT treatment, with a follow-up of up to 60 months. No side effects were shown. This is the first report showing long term efficacy of half-dose PDT treatment in cases with CCH. The outcomes from this pilot study are comparable with results using full dose PDT protocols and it can be considered as a viable treatment option for CCH during the ongoing global verteporfin shortage.

Cytokine Concentrations in Aqueous Humor of Eyes With Circumscribed Choroidal Hemangioma.

PurposeAnti-vascular endothelial growth factor (anti-VEGF) treatment are now widely used in patients with circumscribed choroidal hemangioma (CCH), however the concentrations of VEGF and other cytokines in CCH patients have not been known before. The study was conducted to compare various cytokine concentrations in the aqueous humor of eyes with CCH and control.MethodsA total of 16 eyes of 16 patients with CCH, and 15 eyes of 15 patients with cataract as the control group were examined. Aqueous humor samples were assessed for 30 angiogenic and inflammatory cytokines by Luminex bead-based multiplex array.ResultsSignificantly, compared with control group, higher concentrations of VEGF-A and IP-10 were found in the CCH patients (P = 0.002 and P < 0.001).ConclusionsVEGF-A and IP-10 might be involved with the angiogenic and antiangiogenic process in CCH patients, which provides new insight into the pathophysiology of CCH and could be potential targets for treatment.

DOUBLE FLUENCE PHOTODYNAMIC THERAPY FOR THE TREATMENT OF CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To evaluate the efficacy and safety of double-fluence photodynamic therapy for the treatment of circumscribed choroidal hemangioma. Retrospective observational study including patients affected by circumscribed choroidal hemangioma and treated with double-fluence photodynamic therapy. The photodynamic therapy was performed with verteporfin infusion intravenously (dose of 6 mg/m2 body surface area over 10 minutes), followed by the application of two consecutive spots of 50 J/cm2 light at 689 nm for 83 seconds. Twenty-three eyes of 23 patients were included. The mean best-corrected visual acuity increased from 20/45 to 20/28, the mean tumor thickness decreased from 2,758 ± 530 µm to 722 ± 314 µm (P < 0.05), and the mean central retinal thickness decreased from 404 ± 209 µm to 188 ± 56 µm (P < 0.05) in 12 months, respectively. A total reabsorption of macular subretinal fluid, cystoid macular edema, and SRF associated with the tumor was obtained within 6 months in all cases, with persistence of tumor-associated intraretinal fluid up to 12 months only in two patients. No cases of side effects or need for retreatment were reported during the follow-up (average time of 25 months). Double-fluence photodynamic therapy is a safe and effective treatment for circumscribed choroidal hemangiomas and should be considered as the first line of treatment for these lesions.

Effect of photodynamic therapy with verteporfin on tumor thickness and best corrected visual acuity in patients with circumscribed choroidal hemangioma: a single-center experience.

The management of circumscribed choroidal hemangioma (CCH) with photodynamic therapy (PDT) using verteporfin has resulted in significant functional and clinical improvement compared with the pre-PDT era. Literature data on factors influencing clinical outcomes and predictors of response to PDT in symptomatic CCH are inconsistent. The aim of this study was to investigate the efficacy of PDT with verteporfin in patients with CCH depending on symptom duration and tumor thickness at baseline. We analyzed the medical records of 37 patients with symptomatic CCH divided into 3 groups according to symptom duration (≤ 50 weeks, 51 - 100 weeks, and > 100 weeks) and into 2 groups according to tumor thickness (≤ 2.3 mm and > 2.3 mm). Patients were subjected to PDT with verteporfin at a concentration of 6 mg/m2 body surface area and a light dose of 50 J/cm2 at a wavelength of 689 nm. The mean number of treatment sessions was 1.57 (range, 1 - 3). Tumor thickness, the transverse and longitudinal diameters of the tumor base, and best corrected visual acuity (BCVA) were evaluated at baseline and at 12 - 15 months after treatment. After PDT, the mean tumor thickness in the whole study group decreased by 1.19 ± 0.66 mm (from 3.14 mm to 1.95 mm). Subgroup analyses revealed no significant differences between the 2 groups divided according to tumor thickness (p = 0.49). However, tumor thickness differed significantly between the 3 groups divided according to symptom duration (p < 0.05). BCVA increased in 22 patients (59.5%), remained unchanged in 12 patients (16.2%), and decreased in 3 patients (10.1%). Our study provides evidence for the efficacy of PDT with verteporfin in terms of improving or stabilizing visual function as well as reducing tumor thickness in patients with CCH, including those with long-lasting disease.

Therapeutic effect of modified double-dose photodynamic therapy in circumscribed choroidal haemangioma

AimsTo retrospectively compare the therapeutic effect of modified double-dose photodynamic therapy (PDT) with standard-dose PDT in patients with circumscribed choroidal haemangioma (CCH).MethodsThirty-nine patients with CCH were categorised in two groups...

Circumscribed choroidal hemangioma: Comparative efficacy of transpupillary thermotherapy, indocyanine green-enhanced transpupillary thermotherapy, and photodynamic therapy and analysis of baseline clinical features effecting treatment outcomes

PurposeTo compare the efficacy of transpupillary thermotherapy (TTT), indocyanine green-enhanced TTT (ICG-TTT), and photodynamic therapy (PDT) in the management of circumscribed choroidal hemangioma (CCH) and to investigate the baseline clinical features effecting treatment outcomes MethodsRetrospective review of clinical records of 60 eyes with CCH which underwent TTT (25), ICG-TTT (22), or PDT (13). Main study outcomes were 1) final visual acuity (VA) ≤20/200, 2) <2 Snellen lines VA increase, 3) persistent subretinal fluid (SRF), and 4) <20% decrease in tumor thickness. ResultsMultivariable factors associated with final VA ≤20/200 included longer duration of symptoms (p = 0.015), lower initial VA (p = 0.030), and presence of retinoschisis overlying the tumor (p = 0.047). Multivariable factors for <2 Snellen lines VA increase were longer duration of symptoms (p = 0.018) and previous failed treatment (p = 0.003). By multivariable analysis, the only significant factor for persistent SRF was the presence of retinoschisis (p = 0.001). Multivariable factors associated with a decrease in tumor thickness by <20% were smaller initial tumor thickness (p = 0.045) and presence of retinoschisis (p = 0.014). By Pearson Chi-Square/Fisher Exact Test, final VA ≤20/200 rates (48.0%, 13.6%, 30.8% respectively, p = 0.041) and VA improvement by <2 lines rates (64.0%, 27.3%, 38.5% respectively, p = 0.036) were significantly different between TTT, ICG-TTT, and PDT groups. However, by post hoc analysis, ICG-TTT yielded statistically better outcomes compared to TTT with respect to final visual acuity (VA) ≤20/200 (p = 0.012) and <2 Snellen lines VA increase (p = 0.012). ConclusionsLonger symptom duration, previous failed treatment, lower initial VA, and presence of retinoschisis were risk factors for worse visual outcomes. Eyes with retinoschisis displayed more SRF persistence after treatment. Smaller initial tumor thickness and presence of retinoschisis were risk factors for <20% decrease in tumor thickness.

This issue of ACTA, printed and electronic

The cover photo comes from the paper by Wu et al., where the treatment of macular hole retinal detachment with macular plug in highly myopic eyes was studied. A systematic review with network meta-analyses by Halili et al. reveals no significant difference in the efficacy of using either mitomycin-C, 5-fluorouracil or no anti-metabolite in the needling revision of trabeculectomies. Based on the Swedish Pediatric Cataract Register (PECARE) data, it seems that cataract surgery performed after the first month of life decreases glaucoma rate. An Eyesi simulator-based test for the more experienced cataract surgeon was validated by Jacobsen et al. It looks that the simulator modules are relevant in the training of advanced cataract surgical procedures, but is not strong enough to apply the test for certification purposes. Forshaw et al. report that good rod function before cataract surgery is important, as age-related macular degeneration patients with low dark-adapted responses on full-field electroretinography preoperatively have a decrease in subjective vision-related quality of life. A prospective cohort study by Lind et al. indicates that preeclampsia disturbs the growth of children that also have larger optic cup areas and reduced eye motility at 5 years of age with the association of decreased insulin-like growth factor I (IGF-I) levels. Limited single-spot photodynamic therapy seems to be a safe and effective treatment for circumscribed choroidal haemangioma (CCH). As CCH has a relatively high recurrence rate, Stehouwer et al. recommend regular follow-up with optical coherent tomography every 6 months. According to Tvenning et al.'s observation, increased size and subfoveal location of drusenoid pigment epithelial detachment are clearly associated with a decrease in visual acuity and retinal degeneration. Coronary artery bypass surgery independently associated with improved retinal vascular oxygen saturation is shown by Dinesen et al. Casslén et al. evaluated health-related quality of life (HR-QoL), vision-related (VR) QoL and perceptual visual dysfunction (PVD) among individuals with anophthalmia (A) and microphthalmia (M) treated with ocular prosthesis. A/M patients showed poor HR-QoL and increased PVDs. A/M children with subnormal VA led to lower physical health score. Krarup et al. show that the mean total M-chart metamorphopsia score is currently the best end-points to predict patient-reported outcomes of epiretinal membrane surgery. Koefoed et al. propose improvements to the colour vision severity classification standard CIE 143:2001 algorithm based on the Colour Assessment and Diagnosis (CAD): The current CIE 143:2001 algorithm replace by new CAD threshold limits, CAD use as a secondary test to Ishihara’s test and Hardy Rand Rittler or revising the current CIE 143:2001 algorithm by using Ishihara’s test, HRR, Optec 900 and FD15. Kapetanovic et al. show a case, when the retina implant remained functional with no safety concerns at 3 years postsurgical implantation and following visual training. Promisingly, the patient achieved the highest visual acuity so far with an electronic retinal device, with real, digitally unenhanced, reading vision of 0.04 decimal (equivalent to 1.39 LogMAR and 20/500 or 6/150 Snellen). Chinese study shows that the drug maintenance phase was prolonged by intraoperative subretinal anti-VEGF injection in SiO-filled eyes of proliferative diabetic retinopathy (PDR). The authors consider that subretinal injection might be a valuable treatment option for the management of PDR. Patients with diabetic macular oedema and good baseline visual are of increased risk for visual loss if hyperreflective foci disorganization of inner retina layers and ellipsoid zone disruption are present. Busch et al. recommend early treatment with anti-VEGF for those diabetic macular oedema patients. Kim et al.'s prospective cohort study indicates that severity-level-associated neuronal dysfunction coincides with vascular dysfunction in type 2 diabetes once analysed by electroretinography and optical coherent tomography angiography. A higher intake of dietary zinc was associated with a reduced likelihood of subretinal fluid at 1 year in Australian neovascular age-related macular degeneration patients. Showing complexity of dietary intake β-carotene increased the risk of intraretinal fluid and pigment epithelial detachment. Spanish study reveals that fixed bimonthly and treat-and-extent ranibizumab treatments are noninferior to pro re nata in naïve neovascular age-related macular degeneration. Delyfer et al. report that spectral-domain optical coherence tomography examinations have high feasibility in the elderly population and are more sensitive than standard colour images in the analysis of epiretinal membranes. A vitrectomy combined with macular plug provided favourable outcomes over the ≥3-year follow-up period for highly myopic eyes studied by Wu et al. A significant reduction in macular thickness and changes in retinal neural parameters were associated with the severity level of chronic kidney disease in Taiwanese study. Jonas et al. histomorphometric data show marked scleral thinning and spatially correlated Bruch's membrane (BM) defects in myopic scleral staphylomas, while the thickness and density of the choriocapillaris and retinal pigment epithelium and BM thickness did not differ significantly between staphylomatous versus non-staphylomatous eyes. Global Burden of Diseases Study 2017 indicates that middle-income countries are more burdened with refraction disorders and older adults in lower-income countries tend to suffer from refraction disorders at an earlier age. Teixeira et al. compared the surgical success rate of the Baerveldt-XEN and the commercially available flow-restrictor device (Ahmed glaucoma valve – AGV). The AGV presented higher complete success and qualified success rates. Data from the French National Health Insurance Information System between 2008 and 2016 reveal that preserved glaucoma eye drops increase risks in glaucoma surgery when compared with the preservative-free group. Rong et al. observed that nailfold capillary bed abnormalities were observed in both primary open-angle (POAG) and primary angle-closure glaucoma (PACG) patients. The microvascular density and tortuosity degree had a significant negative association with ganglion cell complex thickness and radial peripapillary capillary density in subjects with POAG rather than in PACG. Pseudoexfoliation (PEX) syndrome and glaucoma associated with had no significant effect on intraocular pressure, but it was associated with age and working outdoors in the Kumejina study. Dohse et al. observed that penetrating keratoplasty increases the risk of microbial keratitis rather than endothelial keratoplasty. Schrittenlocher et al. report that Descemet membrane endothelial keratoplasty is a feasible treatment option after failed penetrating keratoplasty. The cross-sectional study by Siedlecki et al. shows that small incision lenticule extraction induces corneal higher-order aberrations that are not markedly affecting on the patient-reported quality of vision or specific long-term visual symptoms. Arteriovenous difference in oxygen saturation, retinal blood flow and arterial vessel diameter was reduced in mild cognitive impairment and Alzheimer's disease patients reported by Szegedi et al. Intravitreal aflibercept for treatment of macular oedema associated with immune recovery uveitis was studied by Rothova et al. B12 deficiency, optic neuropathy and cyanocobalamin nasal spray were compared in the study of Kaisari et al. Colantuono et al. discuss for AMD Management During the COVID-19 Pandemic. Deng et al. write for low risk of SARS-CoV-2 transmission through the ocular surface. I hope you find interesting topics about this issue of Acta, Stay safe,

An Asymptomatic Circumscribed Choroidal Hemangioma: A Case Report

This paper reviews the clinical characteristics of a circumscribed choroidal hemangioma (CCH). This rare, benign ocular tumor often goes undiagnosed until it causes secondary complications such as macular edema. It is critical to differentiate a CCH from malignant posterior segment tumors such as choroidal melanoma. Ocular photodynamic therapy is an important treatment option for patients with symptomatic CCH. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/an-asymptomatic-circumscribed-choroidal-hemangioma-a-case-report) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Circumscribed choroidal haemangioma: Indocyanine green angiography features on scanning laser ophthalmoscopy versus traditional digital fundus photography.

Circumscribed choroidal haemangioma (CCH) has several characteristic clinical and angiographic features. We aimed to compare indocyanine green angiography (ICG) findings of CCH captured on a traditional digital camera system (DCS) to newer scanning laser ophthalmoscopy (SLO) platforms. A total of 35 patients over a 10-year period diagnosed with CCH using ICG were included (18 imaged with DCS and 17 with SLO). On early ICG frames, intrinsic vessels were apparent in two-thirds (12/18; 67%) of the DCS group compared with all of eyes in the SLO group (p = 0.020). In addition, at maximal hyperfluorescence, most eyes imaged with DCS had a feathery appearance (16/18; 89%) compared with those in the SLO group which all (17/17; 100%) displayed a granular appearance (p < 0.001). The presence of hot spots at maximal hyperfluorescence was also more common in the SLO group (12/17; 71%) versus the DCS group (0/18; 0%) (p < 0.001). Finally, intrinsic vessels and vascular loops could be identified throughout the entire duration of the ICG in 100% of the SLO cases (17/17) versus only 11% (2/18) of DCS cases (p < 0.001). The visualization of intrinsic vessels, vascular loops, and "hot spots" in CCH is significantly enhanced with SLO compared with DCS. Many characteristic mid-late angiographic findings of CCH are more optimally visualized on SLO which may negate the need for late frames (>30 min) without compromising diagnostic accuracy.

High recurrence rate in patients with choroidal hemangioma treated with limited single spot photodynamic therapy during long-term follow-up.

PurposeTo evaluate the long‐term follow‐up of patients with a circumscribed choroidal hemangioma (CCH) treated with limited single spot photodynamic therapy (PDT) at the Amsterdam University Medical Center, location AMC (AUMC).MethodsThis cross‐sectional study included 17 patients, treated between 2001 and 2012. Evaluation included best corrected visual acuity, slitlamp examination, fundoscopy, ophthalmic ultrasonography (USG), fluorescein/indocyanine green angiography (FA/ICG), fundus autofluorescence (FAF) and optical coherence tomography (OCT). Primary outcome: recurrence rate, secondary outcomes: long‐term functional and structural changes.ResultsAn unexpected high recurrence rate of 35% (n6) was found with a mean follow‐up time between treatment and recurrence of almost 6 years, range 2.8–10.7 years. With a recurrence, the classical CCH pattern was no longer recognizable on FA or ICG. Signs of leakage were best observed with OCT, and the recurrence could be confirmed with USG. Retreatment with PDT of all recurrences was successful. After a successful initial PDT, the achieved visual acuity (VA) showed a small decrease over time, median VA from 0.10 LogMar to 0.15 LogMar (p 0.09) after a mean follow‐up of 11.36 years (range 5.1–15.5 years). During follow‐up study visit, the OCT revealed a slightly increased thickness of the choroid in 86% of cases at the site of the original tumour, without a clear correlation to the recurrences.ConclusionLimited single spot PDT is a safe and effective treatment for CCH preserving a good VA. However, because of the relatively high recurrence rate found in this study, we recommend regular follow‐up with OCT every 6 months.

SUBFOVEAL CHOROIDAL THICKNESS AND VASCULAR ARCHITECTURE IN FELLOW EYES OF PATIENTS WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To evaluate the subfoveal choroidal thickness (SFCT) and vascular architecture in the fellow eyes of patients with circumscribed choroidal hemangioma (CCH). In this retrospective observational study, patients were selected from outpatient ophthalmology clinics at the Memorial Sloan Kettering Cancer Center and Vitreous Retina Macula Consultants of New York. Subfoveal choroidal thickness was measured using enhanced depth imaging spectral domain optical coherence tomography from the outer portion of Bruch membrane to the choroidal-scleral interface. Choroidal vascular architecture was qualitatively examined. The main outcome measure was SFCT in fellow eyes of patients with CCH, which was compared with an age- and gender-matched control group. Thirty-one fellow eyes (15 right eyes and 16 left eyes) of patients with CCH (23 males and 8 females) were examined. The fellow eye had a mean SFCT of 361.2 ± 99.9 μm compared with 252.0 ± 77.6 μm in the control group (P < 0.0001). Vascular architecture was disorganized in 13 (42%) fellow eyes and 1 (3%) control eye (P < 0.0001), with no apparent gradient of vessel sizes or discrete choroidal layers. The normal association between older age and a thinner choroid existed in control eyes but not in fellow eyes. Hemangioma thickness measured by ultrasound and the presence of subfoveal fluid in the CCH eye did not correlate with the fellow-eye SFCT. In patients with CCH, fellow eyes had thicker SFCT when compared with age- and gender-matched control eyes. Choroidal architecture was often irregular, without segmented vascular layers. These findings suggest that inherent choroidal changes may exist in patients with CCH.

High-dose ruthenium-106 plaque therapy for circumscribed choroidal hemangioma: a retrospective study of 25 Chinese patients.

To evaluate the efficacy and safety of ruthenium-106 (106Ru) plaque radiotherapy at a dose (>50 Gy) higher than recommended (29-50 Gy) for treatment of circumscribed choroidal hemangioma (CCH) in Chinese patients. This retrospective study included 25 symptomatic CCH patients undergoing 106Ru plaque brachytherapy involving 25 eyes between January 2005 and August 2016. Ophthalmic examination was performed at the baseline and at each post-treatment follow-up visit, using best-corrected visual acuity (BCVA), dilated fundus examination, and B-scan ultrasonography. The primary efficacy outcome measures included the changes in BCVA and hemangioma dimensions at the last followup visit from the baseline. The mean follow-up duration was 28.0±26.6 (range, 12-110)mo. All the hemangiomas were located in the posterior pole except for two involving the fovea. The mean apex dose of 106Ru plaque radiotherapy was 84.4±19.7 Gy. The mean BCVA improved from 41.4±29.3 (0-97) at the baseline to 53.0±33.8 (0-97) ETDRS letters at the last visit (P=0.01). The mean hemangioma height declined from 3.98±0.88 (2.40-5.50) mm to 0.84±1.63 (0-6.47) mm (P≤0.001), and the greatest linear diameter (GLD) reduced from 9.36±2.23 (6.80-15.00) to 7.40±2.45 (0-13.00) mm (P≤0.001). Hemangioma size increased in one (4%) eye with a worsened vision, and subretinal fluid completely resolved in all but one patient (4%). Radiation-related retinopathy was observed in two patients at post-treatment 9 and 11mo, respectively. 106Ru plaque brachytherapy at a dose (>50 Gy) higher than recommended (29-50 Gy) is an effective treatment regimen for symptomatic CCH associated with significantly improved visual acuity and a favorable safety profile in Chinese patients.

Effect of prolonged photodynamic therapy irradiation time combined with intravitreal injection of ranibizumab in the treatment of circumscribed choroidal hemangioma

Objective To observe the clinical effect of prolonged photodynamic therapy (PDT) irradiation time combined with intravitreal injection of ranibizumab in the treatment of circumscribed choroidal hemangioma (CCH). Methods A retrospective clinical study. From March 2012 to March 2018, 51 eyes of 51 patients diagnosed in Shenzhen Eye Hospital were included in the study. Among the patients, the tumor of 36 eyes were located in macular area, of 15 eyes were located outside macular area (near center or around optic disc). All patients underwent BCVA, color fundus photography, FFA, ocular B-scan ultrasonography and OCT examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. OCT showed 48 eyes with macular serous retinal detachment. of 36 eyes with tumor located in macular area, the logMAR BCVA was 0.05±0.05, the tumor thickness was 4.5± 2.2 mm, the diameter of tumor was 9.7±3.6 mm. Of 15 eyes with tumor located outside macular area, the logMAR BCVA was 0.32±0.15, the tumor thickness was 3.8±1.4 mm, the diameter of tumor was 7.7± 1.9 mm. PDT was performed for all eyes with the irradiation time of 123 s. After 48 h, all patients received intravitreal injections of 0.5 mg ranibizumab (0.05 ml). At 1, 3 and 6 months after treatment, the same equipment and methods before treatment were used for related examination. BCVA, subretinal effusion (SRF), tumor leakage and size changes were observed. BCVA, tumor thickness and diameter before and after treatment were compared by t test. Results At 6 months after treatment, the tumor was becoming smaller without scar formation. FFA showed that the blood vessels in the tumor were sparse compared with those before treatment, and the fluorescence leakage domain was reduced. OCT showed 43 eyes of macular serous detachment were treated after the combined treatment. The logMAR BCVA were 0.16±0.15 and 0.55±0.21 of the eyes with tumor located in or outside macular area, respectively. The difference of logMAR BCVA between before and after treatment was significant (t=-2.511, -2.676; P=0.036, 0.040). Both the tumor thickness (t=3.416, 3.055; P=0.011, 0.028) and diameter (t=4.385, 4.171; P=0.002, 0.009) of CCH patients were significantly reduced compared with that before treatment. Conclusion The tumor of CCH can be reduced by prolonged PDT irradiation time combined with intravitreal injection of ranibizumab. Key words: Photochemotherapy; Choroid neoplasms/therapy; Hemangioma/therapy; Angiogenesis inhibitors/therapeutic use

Effectiveness and Safety of Intravitreal Injection of Conbercept as an Initial Treatment for Exudative Circumscribed Choroidal Hemangioma

Objective: To investigate the effectiveness and safety of intravitreal injection of conbercept (IVC) as the initial treatment for exudative circumscribed choroidal hemangioma (CCH). Methods: Forty-two eyes of 42 patients received 3 monthly IVC (0.5 mg/0.05 mL) as the initial treatment. Three months later, the patients were assessed for further treatment including observation, reinjection of conbercept, laser photocoagulation (if the lesion was 3,000 μm away from the macular fovea), or photodynamic therapy (PDT; if the lesion was under the macular fovea). Anatomical and functional responses including best corrected visual acuity (BCVA), central foveal thickness (CFT), and tumor size were analyzed. Results: Twenty-three patients (54.76%) were sensitive to the monotherapy of IVC. Fourteen patients (33.33%) were insensitive to IVC and underwent rescue laser photocoagulation, and 5 patients (11.90%) underwent rescue PDT due to insensitivity to IVC treatment at 3 months. For subgroup analysis, although no statistical difference was found for BCVA at any follow-up time point compared to baseline, an increasing tendency of BCVA was found in the IVC group (p> 0.05). The mean CFT decreased significantly from 427.13 ± 214.74 μm at baseline to 259.83 ± 61.68 μm at 6 months in the IVC group (p< 0.05). No influence on tumor size was found in the IVC group. Conclusion: IVC as the initial treatment might be an option for exudative CCH.

Лечение ограниченной гемангиомы хориоидеи: термотерапия или брахитерапия. Сравнительный анализ

Purpose. To carry out a comparative analysis of results in the treatment of the circumscribed choroidal hemangioma (CCH) by methods of diode-laser transpupillary thermotherapy and brachytherapy. Material and methods. The data of treatment of 185 patients (185 eyes) with circumscribed choroidal hemangioma were analyzed, previously the patients were divided into groups by type of treatment. For the comparative analysis, the groups were standardized by tumor thickness, length of the base, tumor localization, follow-up period, initial visual acuity, frequency of detectable retinal detachment. As a result, the group of diode-laser thermotherapy consisted of 54, and the group of brachytherapy – 33 individuals. Results. After the treatment, the average visual acuity after treatment in the group of transpupillary thermotherapy was significantly higher (0.47) than in the group of brachytherapy (0.2) (p=0.0004). It was noted that the improvement of visual acuity after transpupillary thermotherapy was achieved in 27 (53%) cases more often than after brachytherapy – in 5 cases (15%) (p=0.01 χ 2 criterion). Each of the treatment types led to the resorption of the subretinal transudate and the reposition of the detached retina in all cases. In the evaluation of changes in average visual acuity before and after the treatment in each group, there were noted statistically significant differences in the group of transpupillary thermotherapy (0.33 before the treatment, 0.47 after the treatment; p=0.046) and their absence in the group of brachytherapy (0.22 before treatment, 0.2 after treatment; p=0.7). Conclusion. Diode laser transpupillary thermotherapy leads to better functional results compared with brachytherapy. Taking into consideration the absence of surgical trauma in transpupillary thermotherapy and an increased risk of complications in brachytherapy, the priority in the choice of a treatment method for CCH should be given to transpupillary thermotherapy.

Application of Intravitreal Conbercept Injection as a Primary Treatment for Exudative Circumscribed Choroidal Haemangioma

Application of Intravitreal Conbercept Injection as a Primary Treatment for Exudative Circumscribed Choroidal Haemangioma

Circumscribed choroidal haemangioma: clinical and topographical features

AimsTo characterise the clinical and topographical features of circumscribed choroidal haemangioma (CCH) and to visualise the patterns of tumour extent in the ocular fundus.MethodsData on the size, shape and location...