Photothérapie dynamique des hémangiomes choroïdiens

Purpose: To evaluate the safety and efficacy of photodynamic therapy in the management of symptomatic circumscribed choroidal hemangiomas (CCH) with exudative activity. Patients and Methods: This prospective nonrandomized study included eight patients referred to us for management of CCH with exudative activity. PDT was applied by diode laser (689nm) with a light dose of 100J/cm(2) and using verteporfin (6mg/m(2)) IV bolus injection. The treatment spot diameter accurately corresponded to the tumor basal diameter (TBD). Results: The mean tumor thickness before PDT was 3.3 mm (range, 2.7-7.5 mm) and the mean largest TBD was 6.1 mm (range, 5-12mm). All patients were managed with a single PDT application. After a mean follow-up of 24.2 months (range, 17-29 months), all CCH (100%) showed regression of tumor thickness and complete resorption of the serous retinal fluid; 87.5% of the patients showed a flat tumor scar. All CCH showed overlying PDT-related retinal pigmented epithelium atrophic changes. No case of retinal vascular occlusion or recurrent leakage was documented. Five patients (62.5%) showed visual improvement, one (12.5%) retained stable vision and two (25%) developed worse vision due to chronic exudation-related RPE changes in one patient and preretinal fibrosis in another. Conclusion: PDT using verteporfin offers a safe and effective therapeutic option to manage CCH. Complete resorption of subretinal fluid is usually associated with visual improvement.