Photodynamic therapy for retinal capillary hemangioma

Abstract

Purpose To describe the results of photodynamic therapy (PDT) for juxtapapillary and peripheral retinal capillary hemangioma (RCH). Patients and methods Interventional case series of four eyes (four patients) with juxtapapillary RCH and one eye (one patient) with peripheral RCH. Two eyes with juxtapapillary RCH had received two sessions of full-fluence, double-duration PDT; whereas other two eyes had received single session of half-fluence, single-duration PDT. The peripheral RCH was treated with a single session of full-fluence, single-duration PDT. Results Two patients had von HippelLindau disease. Follow-up duration ranged from 4 months to 1 year. Pre-PDT visual acuity (VA) ranged from 20/200 to HM (juxtapapillary RCH) and 20/100 (peripheral RCH). Among the eyes with juxtapapillary RCH, tumor regression with partial resolution of macular edema was noted in two eyes (one eye each with half-fluence and full-fluence PDT), whereas two eyes had no change in tumor size with persistent macular edema. VA remained stable in three eyes and declined in one eye. In an eye with peripheral RCH, regression of tumor and macular edema with VA improvement was noted. Post-PDT complications included epiretinal membrane (one eye) and transient exudative retinal detachment (one eye). Conclusion PDT can be effective in reducing macular edema associated with RCH but this does not always correspond with an improvement in VA especially for juxtapapillary tumors.

Clinical use of photodynamic therapy in ocular tumors

“…20,29,49,66,140,151,154,201 In only seven of these cases was a good response observed (54% success). 29, 151, 154 Compared to retinal capillary hemangiomas without VHL, there is less scientific evidence to support the effectiveness of PDT in treating VHL.…”

“…186 In two cases, half-fluence was used, and in one patient, a one-and-a-half duration of the standard dose was applied. 34, 140 The only study comparing the modalities in five cases did not find any difference between standard, extended, and half-dose applications of ocular PDT. 140 In 25 of 27 reported cases, there was tumor regression and resolution of exudates (93% response) and stabilization or improvement of visual acuity occurred in 16 cases (59% success).…”

“…34, 140 The only study comparing the modalities in five cases did not find any difference between standard, extended, and half-dose applications of ocular PDT. 140 In 25 of 27 reported cases, there was tumor regression and resolution of exudates (93% response) and stabilization or improvement of visual acuity occurred in 16 cases (59% success). As for complications, there was a transient increase in subretinal fluid in seven cases (26%), 50,118,140,154,166,171,193 intravitreal hemorrhage in three eyes (7%), 16,140,186 fibrosis and macular pucker in two cases (5%) 2 and exudative retinal detachment in one case.…”

“…20,50,151,166,193 In 13 cases, PDT was applied for 166 seconds in the first session. 1, 140,166,113,126,226 Seven of these cases exhibited improved or stable vision, 2, 166,186, 226 four had macular fibrosis, 2, 140 two had a transient increase in exudation, 166,171 and one had vitreous hemorrhage. 186 In two cases, half-fluence was used, and in one patient, a one-and-a-half duration of the standard dose was applied.…”

Phakomatoses and Their Tumors: Genetics and New Treatment Options

“…Despite being the mainstays of treatment, these procedures have their limitations; therefore, PDT (photodynamic therapy) and intravitreal anti-vascular endothelial growth factor (VEGF) are being considered as treatment options. PDT can be helpful in reducing macular edema associated with RCH (retinal capillary hemangioma); however, it has limitations especially for juxtapapillary tumors [93]. VEGF has been tried recently, but the outcomes are variable [94].…”