Session Title: Miscellaneous
Session Date/Time: Thursday 17/09/2015 | 11:00-12:30
Paper Time: 12:04
First Author: : P.Ramos PORTUGAL
Co Author(s): : I. Lains I. Pires M. Cachulo J. Figueira R. Silva
PURPOSE:To evaluate the long-term efficacy of verteporfin photodynamic therapy (PDT) for symptomatic circumscribed choroidal hemangioma (CCH).
Department of Ophthalmology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Association for Innovation and Biomedical Research on Light and Image (Aibili), Coimbra, Portugal. Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Retrospective case-series including patients with symptomatic CCH treated primarily with PDT performed using the standard AMD protocol for infusion and activation of verteporfin (Visudyne, Novartis Ophthalmics, Hettlingen, Switzerland) between November 2002 and May 2010. The treatment spot diameter was calculated on early-phase frames of pretreatment fluorescein angiography (FA). More than one non-overlapping spot was applied in tumors that exceeded the 5400µm. The treatment endpoint was achieved when there was a complete absence of subretinal fluid and macular edema on OCT. Evaluation of best corrected visual acuity (Early Treatment of Diabetic Retinopathy Study (ETDRS) charts), FA, Indocyanine green angiography (ICGA), optical coherence tomography (OCT), and ultrasound were performed before PDT and on follow-up examinations. Univariate and multivariate analysis were used to identify the main predictors of VA in the last follow-up visit.
Eleven eyes of 11 patients mean aged 60.8±12.2 years received isolated PDT treatment for CCH. At baseline all showed a VA ranging from 20/32 to 20/640 and presented subfoveal fluid. In most cases (45.5%, n=5) 2 treatment sessions were required to eliminate the baseline exudation. All but one resolved baseline macular exudation, as evaluated by OCT. In the last follow-up (mean 83.3±42.7 months), tumor thickness had decreased (1.38±1.20 mm versus 2.6±0.63 at baseline) and VA remained stable compared to baseline (0.53±0.53 LogMAR). Multivariate statistical analysis revealed that, controlling for the presence of subretinal fluid, tumors located outside the foveal region (β=0.34, p=.042) and a better initial VA (β= 0.89, p=.002) presented significantly higher final visual acuity (R2 =0.89). No treatment-related adverse events or complications were identified.
PDT was effective and safe in the treatment of CCH, allowing a stabilization of visual acuity and the resolution of macular exudation in most cases. Best final VA outcomes were significantly achieved when tumours were located outside the foveal region and patients presented a better initial VA. To our knowledge, this study represents the longest series available in the literature of CCH treatment with PDT.