Half Fluence Photodynamic Therapy in Peripapillary Circumscribed Choroidal Hemangiomas

Abstract

PurposeTo evaluate the safety and efficacy of half fluence photodynamic therapy (PDT) as treatment for symptomatic peripapillary circumscribed choroidal haemangiomas (CCHs). MethodsIn this prospective, interventional case series; 11 patients with symptomatic peripapillary CCHs presenting to a single centre were treated with half fluence PDT using verteporfin 6 mg/m2 with fluence of 25 mJ/cm2 (standard is 50 mJ/cm2) and other standard settings. Patients were evaluated at baseline, four weeks, twelve weeks and twenty-four weeks post-PDT treatment with best corrected visual acuity (BCVA), ultrasonography, spectral domain- optical coherence tomography (SD-OCT), visual evoked potential and angiographic studies. ResultsEleven patients with peripapillary CCHs received half fluence PDT. The BCVA significantly improved to 0.558 + 0.118 at four weeks post treatment (P=0.014), to 0.494 + 0.114 at twelve weeks (P=0.006) and 0.441 + 0.125 at twenty-four weeks (P=0.007) from baseline levels of 1.017 + 0.075 on log MAR scales. Similar improvement was observed in central macular thickness (CMT) of 78.50 + 13.73 um(P=0.001) at four weeks; 114.70 + 27.73 um(P=0.003) at twelve weeks and 174.60 + 23.13 um(P=0.001) at twenty-four weeks post treatment. A single session of re-treatment was required in 18%(n=2) of patients which also showed complete resolution at last follow-up. No complications were observed without any significant change in retinal nerve fibre layer (RNFL) thickness at six months follow-up(P=0.088).ConclusionsHalf fluence PDT can be an effective and safe treatment option for peripapillary CCHs which results in both anatomical and functional improvements with no observable complications.