Verteporfin photodynamic therapy of six eyes with retinal capillary haemangioma

Abstract

Acta Ophthalmol. 2010: 88: e334–e340 Abstract. Purpose: Single‐centre consecutive interventional case series by retrospective chart review to evaluate the efficacy of verteporfin (Visudyne™) photodynamic therapy (PDT) of retinal capillary haemangioma (RCH). Methods: Following an initial period of observation, six eyes of five patients with RCH (juxtapapillary 3 and extrapapillary (EP) 3) received 1–3 sessions of standard verteporfin PDT upon the development of progressive vision‐threatening complications. Four of the five patients had von Hippel‐Lindau (VHL) disease. Follow‐up included documentation of best‐corrected Snellen visual acuity (BCVA), tumour regression, and presence or absence of subretinal fluid (SRF) and/or lipid exudation as assessed by dilated fundus examination (DFE), fundus photos, and optical coherence tomography (OCT). These parameters were documented at 1 week, 1 month, and 3 months following each PDT session and up to 32 months following the first PDT. Results: All eyes showed favourable response to PDT as defined by tumour regression or stabilization as well as improvement of SRF and lipid exudation. BCVA improved or stabilized in three eyes. Three eyes required PDT retreatment for recurrent SRF. Epiretinal membrane (ERM) worsened in three eyes, requiring vitreoretinal surgery at a median of 6 months following PDT. Conclusions: PDT is a moderately effective treatment for juxtapapillary and EP RCH. In this series, PDT resulted in tumour regression or stabilization as well as in the improvement of SRF and lipid exudation in all cases. However, stabilization or improvement of visual acuity was observed in only 50 per cent of the cases. The treatment benefits may be limited by pre‐existing macular changes and worsening of ERM. A larger prospective study is necessary to validate these findings.

Ocular phototherapy

“…Except in one case wherein the tumour response to PDT was transient, 35 the tumours showed sustained response to PDT including reduced perfusion, shrinkage, and resolution of subretinal fluid. 10,26,34,36 Visual acuity improved or remained stable in the majority of eyes (67%). Visually significant complications such as retinal vascular occlusion, 26 optic neuropathy, 26 vitreous haemorrhage, 26 and tractional retinal detachment 10,36 are observed infrequently.…”

“…10,26,34,36 Visual acuity improved or remained stable in the majority of eyes (67%). Visually significant complications such as retinal vascular occlusion, 26 optic neuropathy, 26 vitreous haemorrhage, 26 and tractional retinal detachment 10,36 are observed infrequently. The treatment parameters are based on settings of the TAP protocol or some modifications of it.…”

“…9 PDT is being increasingly used for treatment of juxtapapillary retinal haemangioma, because of risk of thermal optic nerve damage. 10 Choroidal tumours Choroidal melanoma and choroidal haemangioma have been treated in the past with photocoagulation. As a result of concerns for the lack of efficacy (haemangioma) 11 and recurrences (melanoma) over the long term, 12 photocoagulation has been abandoned in favour of PDT (haemangioma) and radiation plaque therapy (melanoma).…”

“…26 In our own limited experience, PDT of RCH with TAP parameters is moderately effective in treatment of RCH. 10 Retinal vasoproliferative tumour: As these tumours also have distinct vascular component, PDT can be used to achieve tissue sparing treatment. 37 Retinal astrocytic hamartoma: Retinal astrocytomas are benign gliocytic tumours occurring sporadically or in association with tuberous sclerosis.…”

“…26,34 Retinal capillary haemangioma: For reasons outlined above, several investigators have reported their preliminary experience of treating RCH with PDT. 26,[34][35][36] Both extrapapillary 26 and juxtapapillary RCH 10,34,35 have been treated with varying parameters of laser settings. Except in one case wherein the tumour response to PDT was transient, 35 the tumours showed sustained response to PDT including reduced perfusion, shrinkage, and resolution of subretinal fluid.…”