Torosyan Rima, Jaradat Imad, AlJabari Reem, Mohammad Mona, AlNawaiseh Ibrahim, Yousef Yacoub A
Department of Surgery (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan.
Department of Radiation Oncology (Ophthalmology), King Hussein Cancer Centre (KHCC), Amman 11941, Jordan.
Cancers (Basel). 2025 Sep 22;17(18):3087. doi: 10.3390/cancers17183087.
Choroidal hemangioma, a rare benign vascular tumor, can cause visual loss due to subretinal fluid. Photodynamic therapy (PDT) with verteporfin has been the standard treatment, with plaque brachytherapy reserved for PDT failure. Verteporfin is unavailable in many regions in the Middle East, including Jordan, leaving plaque as the main alternative; however, plaque often leads to poor visual outcomes despite tumor control. To improve visual outcomes, we introduced transpupillary thermotherapy (TTT) via laser indirect ophthalmoscopy (LIO) as a practical, widely available, vision-preserving treatment. We retrospectively reviewed 13 patients with choroidal hemangioma treated at King Hussein Cancer Center. Patients received either plaque brachytherapy or LIO-guided TTT. Clinical data included visual acuity at baseline, tumor thickness reduction, subretinal fluid status, and visual outcome. All patients had unilateral circumscribed choroidal hemangioma, and 10 (77%) were males. At diagnosis, the visual acuity was ≤0.5 in all patients (100%) and <0.1 in six (46%) patients. Seven patients (54%) received LIO-guided TTT and six (46%) underwent I-125 plaque brachytherapy. Tumor thickness was 3.0-5.0 mm in 12 (92%) cases; the median thickness in the I-125 plaque brachytherapy group was 4.5 mm (range, 4.5-5.0 mm), whereas in the LIO-guided TTT group it was 3.8 mm (range, 2.9-5.0 mm). At a median follow-up of 20 months (mean 24, range 12-48 months), five out of seven patients (71%) treated with TTT showed significant visual improvement, while the remaining two (29%) had stable vision; none experienced deterioration. In contrast, none of the six plaque-treated patients (0%) demonstrated any improvement in visual acuity; four remained stable and two worsened. This difference was statistically significant ( = 0.021). Tumor thickness was reduced in both groups, with a median reduction of -56% in the plaque group and -36% in the TTT group. All patients achieved complete resolution of subretinal fluid. LIO-guided TTT is an effective vision-preserving treatment for choroidal hemangioma. While both modalities-controlled tumor growth, only TTT resulted in significant visual improvement. This study demonstrates that LIO-guided TTT can replace plaque brachytherapy in regions where verteporfin (PDT) is unavailable, offering an accessible, practical, and superior alternative for preserving vision in patients with choroidal hemangioma.
脉络膜血管瘤是一种罕见的良性血管肿瘤，可因视网膜下液导致视力丧失。维替泊芬光动力疗法（PDT）一直是标准治疗方法，对于PDT治疗失败的情况则采用敷贴近距离放疗。在中东的许多地区，包括约旦，维替泊芬无法获得，这使得敷贴成为主要替代方法；然而，尽管肿瘤得到控制，但敷贴治疗往往导致视力预后不佳。为了改善视力预后，我们通过间接检眼镜激光导入法（LIO）引入经瞳孔温热疗法（TTT），作为一种实用、广泛可用且能保留视力的治疗方法。我们回顾性分析了在侯赛因国王癌症中心接受治疗的13例脉络膜血管瘤患者。患者接受了敷贴近距离放疗或LIO引导下的TTT。临床数据包括基线视力、肿瘤厚度减少情况、视网膜下液状态和视力预后。所有患者均为单侧局限性脉络膜血管瘤，其中10例（77%）为男性。诊断时，所有患者（100%）的视力≤0.5，6例（46%）患者的视力<0.1。7例（54%）患者接受了LIO引导下的TTT，6例（46%）患者接受了碘-¹²⁵敷贴近距离放疗。12例（92%）患者的肿瘤厚度为3.0 - 5.0 mm；碘-¹²⁵敷贴近距离放疗组的中位厚度为4.5 mm（范围4.5 - 5.0 mm），而LIO引导下的TTT组为3.8 mm（范围2.9 - 5.0 mm）。中位随访20个月（平均24个月，范围12 - 48个月）时，接受TTT治疗的7例患者中有5例（71%）视力显著改善，其余2例（29%）视力稳定；无一例视力恶化。相比之下，接受敷贴治疗的6例患者中无一例（0%）视力有任何改善；4例视力稳定，2例视力恶化。这种差异具有统计学意义（P = 0.021）。两组患者的肿瘤厚度均有所减少，敷贴组的中位减少率为 - 56%，TTT组为 - 36%。所有患者的视网膜下液均完全消退。LIO引导下的TTT是一种治疗脉络膜血管瘤有效的保留视力的方法。虽然两种方法都能控制肿瘤生长，但只有TTT能显著改善视力。本研究表明，在无法获得维替泊芬（PDT）的地区，LIO引导下的TTT可替代敷贴近距离放疗，为脉络膜血管瘤患者提供一种可及、实用且更优的保留视力的替代方法。
