Three Cases of Large Retinal Capillary Hemangiomas Treated With Verteporfin and Photodynamic Therapy

Abstract

Objective: To investigate the efficacy of verteporfin and photodynamic therapy in the treatment of large retinal capillary hemangiomas.Methods: Case reports of 3 patients with large retinal capillary hemangiomas treated with photodynamic therapy using verteporfin. Standard verteporfin dosages (6 mg/m 2 of body surface area) were given. Both standard and modified photodynamic protocols were followed. Modified protocols included shorter verteporfin infusion times and longer light exposure times.Results: Pretreatment best-corrected Snellen visual acuity of the 3 affected eyes were 20/100, 20/50, and 2/200, respectively. All cases had associated exudative retinal detachments involving the macula. Cases 1 and 2 were classic endophytic retinal capillary hemangiomas. Case 3 was a reactive retinal capillary hemangioma. Case 1 had 2 photodynamic therapy treatments, and after 8 months, visual acuity improved to 20/40. Two years after initiating photodynamic therapy, the visual acuity was 20/30 and there was no reperfusion of the hemangioma. Case 2 had 3 photodynamic therapy treatments. The hemangioma was fibrotic, and 20 months after initiating photodynamic therapy visual acuity improved to 20/30. Case 3 had 1 treatment, 11 weeks later and visual acuity improved to 20/400. Four months after treatment, visual acuity returned to counting fingers because of tractional elevation of the macula as the capillary hemangioma fibrosed. Vitrectomy surgery was performed, and choroidal and retinal neovascularization was discovered. Three months after vitrectomy visual acuity was 20/ 400. In cases 1 and 2, the capillary hemangioma ultimately regressed, and the exudative detachment resolved.Conclusions: Verteporfin and photodynamic therapy were effective in achieving closure of large retinal capillary hemangiomas. In all cases, the hemangioma underwent fibrosis with consequent macular puckering due to retinal traction. In all cases, the visual acuity improved.

Telangiectatic Capillaries Causing Persistent Diabetic Macular Edema Successfully Treated by Photodynamic Therapy

“…Some cases have reported the success of treatment of vascular diseases such as retinal capillary hemangiomas in Von Hippel–Lindau disease, 8–10 but it was never reported in diabetic retinopathy. In previously reported cases, PDT was used for its capacity of site-specific tumor destruction, sparing of the overlying retina, especially for lesions localized near the fovea, whereas other treatments (e.g., laser photocoagulation) could imply significant morbidities.…”

Telangiectatic Capillaries Causing Persistent Diabetic Macular Edema Successfully Treated by Photodynamic Therapy

“…Some cases have reported the success of treatment of vascular diseases such as retinal capillary hemangiomas in Von Hippel–Lindau disease, 8–10 but it was never reported in diabetic retinopathy. In previously reported cases, PDT was used for its capacity of site-specific tumor destruction, sparing of the overlying retina, especially for lesions localized near the fovea, whereas other treatments (e.g., laser photocoagulation) could imply significant morbidities.…”

Efficacy and safety of current treatment options for peripheral retinal haemangioblastomas: a systematic review

“…The efficacy of this treatment for peripheral e44 tumours is suboptimal as the eradication rate is 64.3%. Furthermore, the iatrogenic fibrosis caused by the application of PDT led in many cases to intrinsic retinal contraction causing epiretinal membrane formation in three cases (21.4%) and tractional retinal detachment in one case (Aaberg et al, 2005;Sachdeva et al 2010). The efficacy of TTT has been questionable for peripheral RH due to insufficient ability to completely eradicate the tumour.…”

The follow-up observation on the therapeutic effect of photodynamic therapy for the juxtapapillary retinal capillary hemangioma: a case report

“…The above treatments exert a specific effect on the treatment of RCH. However, due to the proximity to the optic nerve, the treatment of JRCH usually requires multiple and intense burns and damages to the nerve fiber layer, causing a permanent scotoma and irreversible decline of the VA. Vitreoretinal surgery can also serve as an alternative when glial proliferation leads to epiretinal membrane development or tractional retinal detachment [ 8 ].…”

Telangiectatic Capillaries Causing Persistent Diabetic Macular Edema Successfully Treated by Photodynamic Therapy

“…Some cases have reported the success of treatment of vascular diseases such as retinal capillary hemangiomas in Von Hippel–Lindau disease, 8–10 but it was never reported in diabetic retinopathy. In previously reported cases, PDT was used for its capacity of site-specific tumor destruction, sparing of the overlying retina, especially for lesions localized near the fovea, whereas other treatments (e.g., laser photocoagulation) could imply significant morbidities.…”

Efficacy and safety of current treatment options for peripheral retinal haemangioblastomas: a systematic review

“…The efficacy of this treatment for peripheral e44 tumours is suboptimal as the eradication rate is 64.3%. Furthermore, the iatrogenic fibrosis caused by the application of PDT led in many cases to intrinsic retinal contraction causing epiretinal membrane formation in three cases (21.4%) and tractional retinal detachment in one case (Aaberg et al, 2005;Sachdeva et al 2010). The efficacy of TTT has been questionable for peripheral RH due to insufficient ability to completely eradicate the tumour.…”

The follow-up observation on the therapeutic effect of photodynamic therapy for the juxtapapillary retinal capillary hemangioma: a case report

“…The above treatments exert a specific effect on the treatment of RCH. However, due to the proximity to the optic nerve, the treatment of JRCH usually requires multiple and intense burns and damages to the nerve fiber layer, causing a permanent scotoma and irreversible decline of the VA. Vitreoretinal surgery can also serve as an alternative when glial proliferation leads to epiretinal membrane development or tractional retinal detachment [ 8 ].…”

Telangiectatic Capillaries Causing Persistent Diabetic Macular Edema Successfully Treated by Photodynamic Therapy

“…Some cases have reported the success of treatment of vascular diseases such as retinal capillary hemangiomas in Von Hippel–Lindau disease, 8–10 but it was never reported in diabetic retinopathy. In previously reported cases, PDT was used for its capacity of site-specific tumor destruction, sparing of the overlying retina, especially for lesions localized near the fovea, whereas other treatments (e.g., laser photocoagulation) could imply significant morbidities.…”

Efficacy and safety of current treatment options for peripheral retinal haemangioblastomas: a systematic review

“…The efficacy of this treatment for peripheral e44 tumours is suboptimal as the eradication rate is 64.3%. Furthermore, the iatrogenic fibrosis caused by the application of PDT led in many cases to intrinsic retinal contraction causing epiretinal membrane formation in three cases (21.4%) and tractional retinal detachment in one case (Aaberg et al, 2005;Sachdeva et al 2010). The efficacy of TTT has been questionable for peripheral RH due to insufficient ability to completely eradicate the tumour.…”

The follow-up observation on the therapeutic effect of photodynamic therapy for the juxtapapillary retinal capillary hemangioma: a case report

“…The above treatments exert a specific effect on the treatment of RCH. However, due to the proximity to the optic nerve, the treatment of JRCH usually requires multiple and intense burns and damages to the nerve fiber layer, causing a permanent scotoma and irreversible decline of the VA. Vitreoretinal surgery can also serve as an alternative when glial proliferation leads to epiretinal membrane development or tractional retinal detachment [ 8 ].…”