Evaluation of subretinal fluid absorption by optical coherence tomography in circumscribed choroidal hemangioma after photodynamic therapy with verteporfin

PURPOSE: To determine if optical coherence tomography (OCT) measurements of retinal thickness at the fixation point (RTFP) can be used to confirm the effectiveness of photodynamic therapy (PDT) with verteporfin in the treatment of symptomatic circumscribed choroidal hemangioma (CCH). METHODS: Nine eyes of nine patients with subretinal fluid under foveal centre were treated by PDT with a dose of 6 mg/m(2) of intravenous verteporfin administered 5 minutes before a laser irradiation at 689 nm. Visual outcomes, initial, and final findings were evaluated using biomicroscopy, OCT, ultrasound, fluorescein angiography, and indocyanine green angiography. RESULTS: After a mean follow-up of 8 months (range, 3-18 months) OCT showed absorption of subretinal fluid in all cases (100%). Maximal decrease of RTFP was seen within first month after treatment. Average RTFP decreased from 378 pm (range, 221 mum - 849 mum) preoperatively to 190 mum (range, 118 pm - 321 mum) postoperatively (p=0.017, paired t-test). Mean best corrected visual acuity (BCVA) improved from 4/16 (range, 4/5-1/20) preoperatively to 4/8 (range, 4/3-1/15) postoperatively (p=0.0046, paired t-test). An improvement in BCVA was observed in all cases (100%, one to seven lines on Early Treatment Diabetic Retinopathy Study charts). BCVA returned to 4/5 or better in six patients (67%). Mean tumor height decreased from 3.2 mm (range, 1.5 mm - 4.0 mm) preoperatively to 0.9 mm (range, 0 mm - 2.4 mm) postoperatively (p=0.00003, paired t-test). There was no measurable tumor height in four cases (44%), there were marked reduction in the other five cases (56%) on ultrasound. CONCLUSIONS: OCT appears to be useful method for evaluation of subretinal fluid absorption after the treatment of CCH by PDT with verteporfin. RTFP value can be used for quantification of subretinal fluid under the foveal centre. Functional results of PDT with verteporfin in CCH are limited in pre-existing retinal alterations. Randomised trial with single versus repeated sessions of PDT with verteporfin is needed.