Gambrelle J, Graswill C, Mauget-Faysse M, Kodjikian L, Cochener B, Grange J-D
Service d'ophtalmologie, hôpital Morvan, 5, avenue Foch, 29609 Brest cedex, France.
J Fr Ophtalmol. 2010 Sep;33(7):497-504. doi: 10.1016/j.jfo.2010.06.002. Epub 2010 Jul 31.
Circumscribed choroidal hemangioma (CCH) is an uncommon benign vascular tumor of the choroid that is usually diagnosed when it causes a decrease in vision due to exudative retinal detachment. The classical treatments of CCH were photocoagulation and radiotherapy, which induced additional chorioretinal damage, explaining the poor visual prognosis even in adequately treated patients. It is difficult to compare these two therapeutic options, laser photocoagulation having been abandoned for many years due to the retractile retinal scars that it induced. Conventional radiotherapy and proton therapy with a total dose of 20 Gy gave and give good results but can be performed only by teams used to these types of treatment. Recently, photodynamic therapy (PDT), which allows a selective occlusion of vascular lesions without damaging overlying retinal structures, has emerged as a sound alternative for the treatment of CCH. Most of the clinicians used the standard treatment of age related macular degeneration by photodynamic therapy (TAP) study protocol with or without variations. The main variations brought to the TAP study protocol were the duration of the verteporfin infusion, and/or the increase of the laser power settings, and/or the increase of the duration of exposure, and/or the number of PDT spots (single spot or multiple spots, overlapping or not). Mid-term PDT results are very encouraging. PDT has been reported to bring about resolution of subretinal fluid and to reduce tumor thickness in almost all cases. Visual acuity was improved or stabilized in at least 80% of the cases. Several studies reported on minor local side effects following PDT, consisting of atrophy and proliferation of the retinal pigment epithelium, atrophy of the choroid, transient choroidal effusion, and mild subretinal fibrosis. Published data demonstrated that PDT is a safe and effective alternative to radiotherapy or photocoagulation as first-line therapy for CCH.
局限性脉络膜血管瘤（CCH）是一种罕见的脉络膜良性血管肿瘤，通常在因渗出性视网膜脱离导致视力下降时被诊断出来。CCH的传统治疗方法是光凝和放疗，这会导致额外的脉络膜视网膜损伤，这也解释了即使在接受充分治疗的患者中视力预后也较差的原因。很难比较这两种治疗方案，由于激光光凝会导致视网膜瘢痕收缩，多年来已被弃用。常规放疗和总剂量为20Gy的质子治疗过去和现在都能取得良好效果，但只能由熟悉这些治疗类型的团队进行。最近，光动力疗法（PDT）出现了，它可以选择性地闭塞血管病变而不损害上方的视网膜结构，成为治疗CCH的一种合理选择。大多数临床医生采用或不采用变通方法，按照年龄相关性黄斑变性光动力疗法（TAP）研究方案进行标准治疗。对TAP研究方案的主要变通包括维替泊芬输注的持续时间、和/或激光功率设置的增加、和/或曝光持续时间的增加、和/或PDT光斑的数量（单点或多点，是否重叠）。PDT的中期结果非常令人鼓舞。据报道，PDT几乎在所有病例中都能使视网膜下液消退并减少肿瘤厚度。至少80%的病例视力得到改善或稳定。几项研究报告了PDT后轻微的局部副作用，包括视网膜色素上皮萎缩和增生、脉络膜萎缩、短暂性脉络膜积液和轻度视网膜下纤维化。已发表的数据表明，PDT作为CCH的一线治疗方法，是放疗或光凝的安全有效的替代方法。
