Elsevier

Ophthalmology

Volume 107, Issue 2, February 2000, Pages 351-356
Ophthalmology

Original Articles
Transpupillary thermotherapy for circumscribed choroidal hemangiomas

Presented in part at the annual meeting of the American Academy of Ophthalmology, New Orleans, Louisiana, November 1998.
https://doi.org/10.1016/S0161-6420(99)00046-9Get rights and content

Abstract

Purpose

Various treatments have been described for circumscribed choroidal hemangiomas. We present our results with transpupillary thermotherapy (TTT) with infrared laser that indicate that the therapy is a new, effective treatment for this pathologic condition.

Design

Noncomparative, prospective, interventional case series.

Participants

The treatment and follow-up of eight eyes of eight patients with circumscribed choroidal hemangiomas are presented. Each case was treated when the visual acuity (VA) decreased because of serous retinal detachment that affected the macula.

Methods

Infrared diode laser was used at 810 nm and power between 800 and 1200 mW with a beam diameter of 2 or 3 mm depending on the diameter of the hemangioma, with 3 to 6 minutes of exposure time.

Main outcome measures

The final VA, the presence of serous subretinal fluid, funduscopic appearance of the tumor, and the degree of hyperfluorescence observed during fluorescein angiography were the main parameters.

Results

In all eight cases, total reabsorption of the serous retinal detachment was achieved after one or repeated applications of TTT. Mild choroidal atrophy and minimal hyperpigmentation of the retinal pigment epithelium were observed in the treated eyes.

Conclusions

TTT can be considered an acceptable therapeutic option for choroidal hemangiomas and serous retinal detachment, and we believe that the role of this therapy will expand in the management of these patients.

Section snippets

Patients and methods

A prospective, consecutive, nonrandomized clinical study was conducted from June 1996 through July 1997 in all patients with circumscribed choroidal hemangiomas treated with TTT at the Instituto de Microcirugia Ocular.

The patient data included age, race, visual symptoms, and visual acuity (VA) at the initial examination. The tumor data included the largest tumor base (in millimeters, measured by indirect ophthalmoscopy), the greatest tumor thickness (in millimeters, measured by A- and B-scan

Results

From June 1996 through July 1997, 18 patients with circumscribed choroidal hemangiomas were treated using TTT. Of these, three patients had undergone pars plana vitrectomy before TTT, because the circumscribed choroidal hemangioma was associated with a bullous retinal detachment. Another three of the 18 circumscribed choroidal hemangiomas had been previously treated with argon laser, and in one patient the tumor thickness was 4.5 mm. At the time of data collection, three patients had a

Discussion

The management of circumscribed choroidal hemangiomas varies with the severity of symptoms and the presence or absence of exudative retinal detachment. If the patient is asymptomatic, no treatment is necessary. Because circumscribed choroidal hemangiomas rarely increase in size and may remain quiescent for months or years, the best treatment option may be observation every 6 months. In patients with visual loss because of exudative macular detachment, treatment should be considered.

Various

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    The authors have no proprietary interest in any aspect of this study.

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