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Photothérapie dynamique selon un protocole de laser immédiat post-perfusion 8 minutes sur les hémangiomes choroïdiens circonscrits : une étude rétrospective

Photodynamic therapy (PDT) is the main treatment for Circumscribed Choroidal Hemangioma (CCH). The standard PDT protocol commonly used was first designed for the treatment of Subfoveal Choroidal Neovascularization secondary to age-related macular degeneration, based on regular choroidal vascularization. But, with Indocyanine Green Angiography we know that CCH has an earlier hyperfluorescence than regular choroidal vascularization. In order to get closer to vascular flow in CCH, we have chosen to treat exudative CCH with a specific protocol of PDT. Verteporfin (dose = 6mg/m²) was infused intravenously during an 8-minute period, and followed immediately by laser irradiation. In this study, we evaluate the efficacy and the absence of recurrence after one session of the said PDT protocol.

We retrospectively included patients from one center (Centre Rétine Gallien, Bordeaux). The diagnosis of exudative CCH was performed by only one ocular-oncologist investigator through multimodal analysis using clinical examination, fundus camera, spectral domain optical coherence tomography and ultrasound echography. Verteporfin (dose = 6mg/m²) was infused intravenously during an 8-minute period, followed immediately by laser irradiation, of which the fluence was 50 J/cm2 over 83 seconds. The location, thickness, exudative parameters of HCC and visual acuity were collected from the diagnosis and up to two years after the PDT.

From 2014 to 2020, fourteen patients were included retrospectively. Eleven patients were treatment-naive (group 1) and three patients (group 2) had pre-treatment (one to two sessions of photodynamic therapy with a standard protocol). The median initial thickness was 2,4mm [1,5mm - 3,2mm]. All patients had serous retinal detachment and four of them had associated macular edema. After the treatment, no patient from group 1 had exudative recurrence and only one patient from group 2 had an exudative recurrence, treated by a second session of PDT. Most of the patients experienced an improvement in visual acuity.

Our results suggest that an early laser irradiance achieves complete fluid resorption in one session. Several studies proved that PDT is an effective treatment, but it is not unusual to require multiple sessions.

Early laser irradiance photodynamic therapy is effective and safe for treating exudative CCH and may provide better results than a standard PDT protocol.