Double Fluence Photodynamic Therapy for the Treatment of Circumscribed Choroidal Hemangioma

Pellegrini, Marco; Staurenghi, Giovanni; Mambretti, Manuela; Preziosa, Chiara

doi:10.1097/iae.0000000000003373

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Otherwise, in the case of multispot treatment, overlapping spots have historically been avoided due to the theoretical risk of increased side effects [ 11 ]. A 2014 study conducted by Su et al [ 3 ] showed no complications in overlapping treatment at the conventional 50 J/cm 2 light dose compared to single spot treatment, and more recent studies have suggested the superiority of the double-fluence protocol with 100% tumor regression and SRF resolution after a single treatment session with no need for retreatment, whereas previous cases utilizing the standard protocol showed retreatment rates of 12–80% of cases [ 3 , 8 , 12 ]. Notably, choroidal ischemia and atrophy have typically been reported in cases requiring three or more sessions of PDT [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Overlapping Spots of Photodynamic Therapy for Treatment of Choroidal Hemangioma in Sturge-Weber Syndrome: A Case Report

Pai,

Han,

Mosaed

et al. 2024

Case Rep Ophthalmol

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Introduction: Photodynamic therapy (PDT) has shown substantial benefit in the treatment of choroidal hemangioma (CH) in recent years. This report describes the use of PDT with overlapping spots in a patient with Sturge-Weber syndrome (SWS) and large circumscribed CH. Case Presentation: A 9-year-old girl with SWS and a history of glaucoma in her left eye was referred to a retina clinic for possible macular changes. Examination revealed decreased vision in the left eye, pigmentary changes in the macula, and choroidal thickening in the posterior pole. After being lost to follow-up for 2 years, the patient returned with further vision deterioration with best-corrected visual acuity (BCVA) of 20/150 and new subretinal fluid (SRF). Imaging findings were consistent with a diagnosis of CH and SRF. PDT with verteporfin was initiated on the entire area with multiple overlapping spots, resulting in resolution of SRF and improvement in visual acuity and choroidal contour. At 18-month post-treatment, the patient’s BCVA was 20/25 with no recurrence of SRF or increased choroidal thickening. Significant pigmentary changes and subretinal hyper-reflective material were observed in the OCT of the treated area. Conclusion: Multiple overlapping laser spots of PDT can result in longstanding regression of large circumscribed CH in a patient with SWS with excellent final visual acuity. However, significant subretinal changes may also result following this method of treatment.

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Section: Discussionmentioning

confidence: 99%

“…protocol showed retreatment rates of 12-80% of cases [3,8,12]. Notably, choroidal ischemia and atrophy have typically been reported in cases requiring three or more sessions of PDT [8].…”

Section: Case Reports In Ophthalmologymentioning

confidence: 99%

Overlapping Spots of Photodynamic Therapy for Treatment of Choroidal Hemangioma in Sturge-Weber Syndrome: A Case Report

Pai,

Han,

Mosaed

et al. 2024

Case Rep Ophthalmol

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“…There are a variety of indications for PDT with verteporfin that include the treatment of choroidal neovascularization in myopia, age-related macular degeneration, and presumed ocular histoplasmosis syndrome, as it offers selective laser stimulation of choroidal vascularized structures [9][10][11][12]. In CCH, PDT is considered the primary line of management modalities using a variable number of protocols that vary in timing of infusion, dosages, levels of energy, timing of application of laser, spot sizes, single or overlapping spots, and repeating or not repeating the treatment [3,13].…”

Section: Introductionmentioning

confidence: 99%

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

Alshehri,

AlAhmadi,

Alhumaid

et al. 2023

Cureus

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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.

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New insights on circumscribed choroidal hemangioma: “bench to bedside”

Lupidi

Centini

Castellucci

et al. 2023

Graefes Arch Clin Exp Ophthalmol

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Circumscribed choroidal hemangioma is a rare vascular hamartoma of the choroid, presenting as a red–orange mass at the posterior pole on fundoscopic examination. Despite its benign origin, associated complications such as subretinal fluid, serous retinal detachment, retinoschisis and neovascular glaucoma may lead to serious visual impairment in more than half patients. Because of its similarity to amelanotic choroidal melanoma and choroidal metastasis, differential diagnosis is still challenging for specialists. Multimodal imaging such as ultrasonography, fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography guides the clinician to the correct diagnosis and the proper follow-up. Treatment is indicated in symptomatic cases in order to resolve exudation and improve visual acuity. Treatment options include photocoagulation, transpupillary thermotherapy, radiation therapy, photodynamic therapy and anti-vascular endothelial growth factor therapy. Currently, photodynamic therapy is the treatment of choice due to its effectiveness and safety. The purpose of this review is to describe the latest knowledge in the etiopathogenesis of the circumscribed choroidal hemangioma, the most recent multimodal imaging findings, and the available treatment options.

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Double Fluence Photodynamic Therapy for the Treatment of Circumscribed Choroidal Hemangioma

Abstract: Double-fluence photodynamic therapy is an effective and safe procedure to treat circumscribed choroidal hemangioma and its complications.

Cited by 6 publications

References 26 publications

Overlapping Spots of Photodynamic Therapy for Treatment of Choroidal Hemangioma in Sturge-Weber Syndrome: A Case Report

Overlapping Spots of Photodynamic Therapy for Treatment of Choroidal Hemangioma in Sturge-Weber Syndrome: A Case Report

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

New insights on circumscribed choroidal hemangioma: “bench to bedside”

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