Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Ophthalmol Retina. 2020 Oct;4(10):1024-1033. doi: 10.1016/j.oret.2020.04.018. Epub 2020 Apr 25.
To determine factors predictive of visual outcome in patients with circumscribed choroidal hemangioma treated with photodynamic therapy (PDT).
Retrospective case series.
Seventy-nine patients with circumscribed choroidal hemangioma treated with PDT.
Patients with circumscribed choroidal hemangioma treated with PDT were identified, and factors predictive of final visual acuity were assessed.
Factors predictive of final visual acuity of 20/40 or better versus 20/50 or worse.
Seventy-nine eyes of 79 patients with circumscribed choroidal hemangioma were treated with PDT. All tumors were unilateral and posterior to the equator. Mean largest basal diameter was 5.7 mm (range, 2.0-10.0 mm); mean thickness was 3.0 mm (range, 1.4-4.5 mm). A total of 116 PDT sessions were performed (mean, 1.5 sessions; range, 1.0-7.0 sessions). Standard duration PDT was used in most cases (83 seconds; n = 110/116 [95%]). Mean follow-up was 43 months. Of 79 patients, 49 (62%) demonstrated good visual acuity (≥20/40) and 30 (38%) showed intermediate to poor visual acuity (≤20/50) after PDT. A comparison (final visual acuity, good vs. intermediate to poor) revealed a statistically significant difference in baseline features of photopsia (100% vs. 0%; P = 0.04), initial visual acuity of 20/40 or better (77% vs. 23%; P < 0.001), mean tumor basal diameter (5.4 mm vs. 6.2 mm; P = 0.03), mean tumor thickness (2.9 mm vs. 3.2 mm; P = 0.01), cystoid macular edema (CME) involving the foveola (30% vs. 70%; P = 0.001), retinal edema overlying the lesion (39% vs. 61%; P = 0.003), retinoschisis involving the foveola (0% vs. 100%; P = 0.002), lack of CME regardless of foveola involvement at presentation (79% vs. 21%; P < 0.001), previous treatment (33% vs. 67%; P = 0.04), and CME progression after treatment (0% vs. 100%; P = 0.006). Partial or complete resolution of subretinal fluid was achieved in 93% of patients.
In this comparative analysis, PDT was an effective treatment method for circumscribed choroidal hemangioma. Good final visual outcome (≥20/40) was correlated with good baseline visual acuity, smaller tumor size, lack of CME, and lack of treatment before PDT.
确定接受光动力疗法 (PDT) 治疗的局限性脉络膜血管瘤患者的视觉结果的预测因素。
回顾性病例系列。
79 例接受 PDT 治疗的局限性脉络膜血管瘤患者。
确定接受 PDT 治疗的局限性脉络膜血管瘤患者，并评估预测最终视力的因素。
预测最终视力为 20/40 或更好与 20/50 或更差的因素。
79 例局限性脉络膜血管瘤患者的 79 只眼接受 PDT 治疗。所有肿瘤均位于单侧赤道后。平均最大基底直径为 5.7mm（范围 2.0-10.0mm）；平均厚度为 3.0mm（范围 1.4-4.5mm）。共进行了 116 次 PDT 治疗（平均 1.5 次；范围 1.0-7.0 次）。大多数情况下使用标准持续时间 PDT（83 秒；n=110/116[95%]）。平均随访时间为 43 个月。在 79 例患者中，49 例（62%）在 PDT 后视力良好（≥20/40），30 例（38%）视力中等至较差（≤20/50）。（最终视力，好 vs. 中等至差）的比较显示，在光幻视的基线特征（100% vs. 0%；P=0.04）、初始视力为 20/40 或更好（77% vs. 23%；P<0.001）、平均肿瘤基底直径（5.4mm vs. 6.2mm；P=0.03）、平均肿瘤厚度（2.9mm vs. 3.2mm；P=0.01）、黄斑区囊样水肿（CME）累及中心凹（30% vs. 70%；P=0.001）、病变上方视网膜水肿（39% vs. 61%；P=0.003）、累及中心凹的视网膜劈裂（0% vs. 100%；P=0.002）、无论病变中心凹是否受累，治疗前均无 CME（79% vs. 21%；P<0.001）、先前治疗（33% vs. 67%；P=0.04）和治疗后 CME 进展（0% vs. 100%；P=0.006）方面存在显著差异。93%的患者实现了视网膜下液的部分或完全消退。
在这项对比分析中，PDT 是治疗局限性脉络膜血管瘤的有效方法。良好的最终视力（≥20/40）与良好的基线视力、较小的肿瘤大小、无 CME 和 PDT 前无治疗相关。
