J Korean Ophthalmol Soc.  2017 Mar;58(3):289-295. 10.3341/jkos.2017.58.3.289.

Treatment Outcome of Serous Macular Detachment in Circumscribed Choroidal Hemangioma

• Kwon JM
• Lee SM
• Kwon HJ
• Park SW
• Lee JE
• Byon IS

• KMID: 2371909
• DOI: http://doi.org/10.3341/jkos.2017.58.3.289

Abstract

PURPOSE
To determine the clinical outcome of anti-vascular endothelial growth factor (anti-VEGF) and photodynamic therapy (PDT) for circumscribed choroidal hemangioma (CCH) with serous retinal detachment.
METHODS
The medical records of patients having CCH with serous retinal detachment in macula were retrospectively reviewed. CCH and serous retinal detachment were evaluated via fundus photography, optical coherence tomography, indocyanine green angiography, and ultrasonography.
RESULTS
A total of 9 eyes were enrolled in this study. The average follow-up period was 19.2 months. The mean visual acuity was 0.51 ± 0.52 (logMAR) and the mean maximum diameter and thickness of the tumor were 6,154.4 ± 2,019.9 µm and 2,224.4 ± 862.1 µm, respectively. Of the 6 eyes receiving anti-VEGF (mean number of injections: 3.16) as the first treatment for serous retinal detachment, 5 had sustained or recurred intraretinal/subretinal fluid (IRF/SRF) and needed additional PDT and transpupillary thermotherapy. In the 3 eyes that received PDT (mean number of treatments: 1.3) as an initial treatment, IRF/SRF was completely resolved. Finally, 8 eyes achieved complete resolution of SRF and IRF; however visual recovery was limited.
CONCLUSIONS
PDT, even with a small number of treatments, can alleviate IRF/SRF in CCH, while anti-VEGF did not.

Keyword

Circumscribed choroidal hemangioma; Serous retinal detachment; Photodynamic therapy

MeSH Terms

Angiography
Choroid*
Endothelial Growth Factors
Follow-Up Studies
Hemangioma*
Humans
Hyperthermia, Induced
Indocyanine Green
Medical Records
Photochemotherapy
Photography
Retinal Detachment
Retrospective Studies
Tomography, Optical Coherence
Treatment Outcome*
Ultrasonography
Visual Acuity
Endothelial Growth Factors
Indocyanine Green

Figure

• 

  Figure 1. Representative case 4 having an exudative retinal detachment in circumscribed choroidal hemangioma (CCH). (A) At the presentation, fundus photograph showed that an orange colored CCH at the supero-nasal macula in the left eye. Indocyanine green angiography and ultrasonography showed CCH at the same location. Optical coherence tomography showed subretinal fluid (SRF) at the macula. The central macular thickness was 542 μ m and visual acuity was 0.4 (logMAR). The maximum diameter and thick-ness of the tumor was 2,840 μ m and 1,210 μ m, respectively. (B) Six months after intravitreal bevacizumab injection, SRF did not change. Visual acuity was 0.4. (C) Two months after photodynamic therapy, SRF disappeared, macualr thickness decreased to 204 μ m and visual acuity increased to 0.1. Exduative retinal detachment did not recur during 9 months follow-up period.

• 

  Figure 2. Representative case 9 having an exudative retinal detachment in circumscribed choroidal hemangioma (CCH). (A) At the presentation, fundus photograph showed that an orange colored CCH at the infero-nasal macula in the right eye. Indocyanine green angiography and ultrasonography showed CCH at the same location. Optical coherence tomography showed intraretinal and sub-retinal fluid (intraretinal fluid [IRF]/subretinal fluid [SRF]) at the macula. The central macular thickness was 400 μ m and visual acuity was 0.2 (logMAR). The maximum diameter and thickness of the tumor was 7,910 μ m and 2,830 μ m, respectively. (B) Two months after photodynamic therapy, IRF/SRF disappeared, central macular thickness decreased to 220 μ m but visual acuity did not changed. Exudative retinal detachment did not recur during 10 months follow-up period.

Reference

References

1. Augsburger JJ, Shields JA, Moffat KP. Circumscribed choroidal hemangiomas: long-term visual prognosis. Retina. 1981; 1:56–61.

2. Chisholm IH, Blach RK. Choroidal hemangioma, a diagnostic and therapeutic problem. Trans Ophthalmol Soc U K. 1973; 93:161–9.

3. Ferry AP. Lesions mistaken for malignant melanoma of the posteri-or uvea. A clinicopathologic analysis of 100 cases with oph-thalmoscopically visible lesions. Arch Ophthalmol. 1964; 72:463–9.

4. Gass JDM. Differential Diagnosis of Intraocular Tumors: a Stereoscopic Presentation. 1st ed. St. Louis: Mosby;1974. p. 113–38.

5. Kamal A, Watts AR, Rennie IG. Indocyanine green enhanced trans-pupillary thermotherapy of circumscribed choroidal haemangioma. Eye (Lond). 2000; 14(Pt 5):701–5.

6. Schmidt-Erfurth U, Hasan T.Mechanisms of action of photo-dynamic therapy with verteporfin for the treatment of age-related macular degeneration. Surv Ophthalmol. 2000; 45:195–214.

7. Witschel H, Font RL. Hemangioma of the choroid. A clinicopatho-logic study of 71 cases and a review of the literature. Surv Ophthalmol. 1976; 20:415–31.

8. Mashayekhi A, Shields CL. Circumscribed choroidal hemangioma. Curr Opin Ophthalmol. 2003; 14:142–9.

9. Mandal S, Naithani P, Venkatesh P, Garg S. Intravitreal bev-acizumab (avastin) for circumscribed choroidal hemangioma. Indian J Ophthalmol. 2011; 59:248–51.

10. Vicuna-Kojchen J, Banin E, Averbukh E. . Application of the standard photodynamic treatment protocol for symptomatic cir-cumscribed choroidal hemangioma. Ophthalmologica. 2006; 220:351–5.

11. Singh AD, Kaiser PK, Sears JE. . Photodynamic therapy of cir-cumscribed choroidal haemangioma. Br J Ophthalmol. 2004; 88:1414–8.

12. Gündüz K.Transpupillary thermotherapy in the management of circumscribed choroidal hemangioma. Surv Ophthalmol. 2004; 49:316–27.

13. Kivelä T, Tenhunen M, Joensuu T. . Stereotactic radiotherapy of symptomatic circumscribed choroidal hemangiomas. Ophthalmology. 2003; 110:1977–82.

14. Sanborn GE, Augsburger JJ, Shields JA. Treatment of circum-scribed choroidal hemangiomas. Ophthalmology. 1982; 89:1374–80.

15. Ritland JS, Eide N, Tausjø J.External beam irradiation therapy for choroidal haemangiomas. Visual and anatomical results after a dose of 20 to 25 Gy. Acta Ophthalmol Scand. 2001; 79:184–6.

16. Frau E, Rumen F, Noel G. . Low-dose proton beam therapy for circumscribed choroidal hemangiomas. Arch Ophthalmol. 2004; 122:1471–5.

17. Nicholson BP, Schachat AP. A review of clinical trials of an-ti-VEGF agents for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2010; 248:915–30.

18. Noma H, Funatsu H, Yamasaki M. . Pathogenesis of macular edema with branch retinal vein occlusion and intraocular levels of vascular endothelial growth factor and interleukin-6. Am J Ophthalmol. 2005; 140:256–61.

19. Wang W, Dentler WL, Borchardt RT. VEGF increases BMEC monolayer permeability by affecting occludin expression and tight junction assembly. Am J Physiol Heart Circ Physiol. 2001; 280:H434–40.

20. Kenawy N, Groenwald C, Damato B. Treatment of a vaso-proliferative tumour with intravitreal bevacizumab (Avastin). Eye (Lond). 2007; 21:893–4.

21. Kwon HJ, Kim M, Lee CS, Lee SC. Treatment of serous macular detachment associated with circumscribed choroidal hemangioma. Am J Ophthalmol. 2012; 154:137–45.

22. Soucek P, Cihelková I.Evaluation of subretinal fluid absorption by optical coherence tomography in circumscribed choroidal he-mangioma after photodynamic therapy with verteporfin. Neuro Endocrinol Left. 2004; 25:109–14.

23. Barbazetto I, Schmidt-Erfurth U. Photodynamic therapy of choroi-dal hemangioma: two case reports. Graefes Arch Clin Exp Ophthalmol. 2000; 238:214–21.

24. . . Photodynamic therapy for symptomatic choroidal hemangioma: visual and ana-tomic results. Ophthalmology. 2002; 109:2284–94.

25. Porrini G, Giovannini A, Amato G. . Photodynamic therapy of circumscribed choroidal hemangioma. Ophthalmology. 2003; 110:674–80.

26. Jurklies B, Bornfeld N. The role of photodynamic therapy in the treatment of symptomatic choroidal hemangioma. Graefes Arch Clin Exp Ophthalmol. 2005; 243:393–6.

27. Boixadera A, García-Arumí J, Martínez-Castillo V. . Prospective clinical trial evaluating the efficacy of photodynamic therapy for symptomatic circumscribed choroidal hemangioma. Ophthalmology. 2009; 116:100–5.

28. Jurklies B, Anastassiou G, Ortmans S. . Photodynamic therapy using verteporfin in circumscribed choroidal haemangioma. Br J Ophthalmol. 2003; 87:84–9.

29. Verbraak FD, Schlingemann RO, de Smet MD, Keunen JE. Single spot PDT in patients with circumscribed haemangioma and near normal visual acuity. Graefes Arch Clin Exp Ophthalmol. 2006; 244:1178–82.

30. Sagong M, Lee J, Chang W. Application of intravitreal bev-acizumab for circumscribed choroidal hemangioma. Korean J Ophthalmol. 2009; 23:127–31.

31. García-Arumí J, Ramsay LS, Guraya BC.Transpupillary thermo-therapy for circumscribed choroidal hemangiomas. Ophthalmology. 2000; 107:351–6.